Provider Demographics
NPI:1417187436
Name:EYECARE GROUP LLC
Entity Type:Organization
Organization Name:EYECARE GROUP LLC
Other - Org Name:BAYSHORE OPTICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:VAN
Authorized Official - Middle Name:
Authorized Official - Last Name:HUYNH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-944-4828
Mailing Address - Street 1:5150 CRENSHAW RD UNIT 4
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:TX
Mailing Address - Zip Code:77505-3094
Mailing Address - Country:US
Mailing Address - Phone:713-944-4828
Mailing Address - Fax:
Practice Address - Street 1:3917 SHAVER ST
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:TX
Practice Address - Zip Code:77504-2603
Practice Address - Country:US
Practice Address - Phone:713-941-6662
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-24
Last Update Date:2009-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX149068202Medicaid
TXU87388Medicare UPIN