Provider Demographics
NPI:1437387834
Name:MIDLAND EYE NETWORK,LLP
Entity Type:Organization
Organization Name:MIDLAND EYE NETWORK,LLP
Other - Org Name:LASER NETWORK
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:
Authorized Official - Last Name:GRIGSBY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:432-694-5259
Mailing Address - Street 1:4109 N MIDLAND DR
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79707-3500
Mailing Address - Country:US
Mailing Address - Phone:432-559-2227
Mailing Address - Fax:
Practice Address - Street 1:4109 N MIDLAND DR
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79707-3500
Practice Address - Country:US
Practice Address - Phone:432-559-2227
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-24
Last Update Date:2009-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3040TG152WC0802X
TX2219TG152WC0802X
TX3317TG152WC0802X
TX3896TG152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2219TGOtherOPTOMETRY LICENSE 2 COOK
TX3317TGOtherOPTOMETRY LICENSE 3 NEELY
TX3040TGOtherOPTOMETRY LICENSE
TX3896TGOtherOPTOMETRY LICENSE 4 SHEETS