Provider Demographics
NPI:1477655751
Name:CITEK, JAMES F (O D)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:F
Last Name:CITEK
Suffix:
Gender:M
Credentials:O D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1818 N VELASCO ST
Mailing Address - Street 2:
Mailing Address - City:ANGLETON
Mailing Address - State:TX
Mailing Address - Zip Code:77515-3015
Mailing Address - Country:US
Mailing Address - Phone:979-849-2331
Mailing Address - Fax:979-849-7520
Practice Address - Street 1:1818 N VELASCO ST
Practice Address - Street 2:
Practice Address - City:ANGLETON
Practice Address - State:TX
Practice Address - Zip Code:77515-3015
Practice Address - Country:US
Practice Address - Phone:979-849-2331
Practice Address - Fax:979-849-7520
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-05
Last Update Date:2012-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2698-TG152WV0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WV0400XEye and Vision Services ProvidersOptometristVision Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX80749QOtherBLUE CROSS BLUE SHIELD
TX112482804Medicaid
TX155956901Medicaid
TX80749QOtherBLUE CROSS BLUE SHIELD
TXT12659Medicare UPIN