Provider Demographics
NPI:1508063504
Name:WHITNEY FAMILY EYECARE P.C.
Entity Type:Organization
Organization Name:WHITNEY FAMILY EYECARE P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LON
Authorized Official - Middle Name:WHITFIELD
Authorized Official - Last Name:EUBANK
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:254-694-3435
Mailing Address - Street 1:PO BOX 2067
Mailing Address - Street 2:
Mailing Address - City:WHITNEY
Mailing Address - State:TX
Mailing Address - Zip Code:76692-5067
Mailing Address - Country:US
Mailing Address - Phone:254-694-3435
Mailing Address - Fax:254-694-9968
Practice Address - Street 1:1221 N. BRAZOS STREET
Practice Address - Street 2:SUITE B
Practice Address - City:WHITNEY
Practice Address - State:TX
Practice Address - Zip Code:76692
Practice Address - Country:US
Practice Address - Phone:254-694-3435
Practice Address - Fax:254-694-9968
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-02
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5119TG332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1427134493OtherDR. NPI NUMBER
TX019553901Medicaid
TX00E89TMedicare ID - Type Unspecified
TX019553901Medicaid
TX6009120001Medicare NSC