Provider Demographics
NPI:1497707905
Name:CONROE EYE CLINIC, LLP
Entity Type:Organization
Organization Name:CONROE EYE CLINIC, LLP
Other - Org Name:(1) CONROE WOODLANDS EYE CLINIC, (2) WOODLANDS EYE CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:EDNA
Authorized Official - Middle Name:
Authorized Official - Last Name:PRICE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:936-441-1440
Mailing Address - Street 1:333 N RIVERSHIRE DR
Mailing Address - Street 2:STE. 160
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77304-0001
Mailing Address - Country:US
Mailing Address - Phone:936-441-2020
Mailing Address - Fax:936-756-0656
Practice Address - Street 1:333 N RIVERSHIRE DR
Practice Address - Street 2:STE. 160
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77304-0001
Practice Address - Country:US
Practice Address - Phone:936-441-2020
Practice Address - Fax:936-756-0656
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-16
Last Update Date:2007-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CP8892OtherRAILROAD
00183KOtherBLUECROSS
0623950001OtherDMERC
00183KMedicare ID - Type Unspecified