Provider Demographics
NPI:1477866754
Name:EYE GROUP OF PALESTINE, PA
Entity Type:Organization
Organization Name:EYE GROUP OF PALESTINE, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:RANDALL
Authorized Official - Last Name:RAND
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:903-723-1010
Mailing Address - Street 1:3323 S LOOP 256
Mailing Address - Street 2:
Mailing Address - City:PALESTINE
Mailing Address - State:TX
Mailing Address - Zip Code:75801-6977
Mailing Address - Country:US
Mailing Address - Phone:903-723-1010
Mailing Address - Fax:903-723-0314
Practice Address - Street 1:3323 S LOOP 256
Practice Address - Street 2:
Practice Address - City:PALESTINE
Practice Address - State:TX
Practice Address - Zip Code:75801-6977
Practice Address - Country:US
Practice Address - Phone:903-723-1010
Practice Address - Fax:903-723-0314
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-15
Last Update Date:2010-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX06323152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty