Provider Demographics
NPI:1457625717
Name:GUILLEN EYECARE PLLC
Entity Type:Organization
Organization Name:GUILLEN EYECARE PLLC
Other - Org Name:DONNA EYE CLINIC & OPTICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:GUILLEN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:956-464-8160
Mailing Address - Street 1:301 N D SALINAS AVE
Mailing Address - Street 2:
Mailing Address - City:DONNA
Mailing Address - State:TX
Mailing Address - Zip Code:78537-2929
Mailing Address - Country:US
Mailing Address - Phone:956-464-8160
Mailing Address - Fax:956-464-8535
Practice Address - Street 1:301 N D SALINAS AVE
Practice Address - Street 2:
Practice Address - City:DONNA
Practice Address - State:TX
Practice Address - Zip Code:78537-2929
Practice Address - Country:US
Practice Address - Phone:956-464-8160
Practice Address - Fax:956-464-8535
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-05
Last Update Date:2012-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7556TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB 149768Medicare PIN