Provider Demographics
NPI:1508934738
Name:BELLAIRE FAMILY EYE CARE PA
Entity Type:Organization
Organization Name:BELLAIRE FAMILY EYE CARE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INSURANCE CLERK
Authorized Official - Prefix:MRS
Authorized Official - First Name:LAURI
Authorized Official - Middle Name:J
Authorized Official - Last Name:STOLL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-664-8087
Mailing Address - Street 1:5001 BISSONNET
Mailing Address - Street 2:SUITE 107
Mailing Address - City:BELLAIRE
Mailing Address - State:TX
Mailing Address - Zip Code:77401
Mailing Address - Country:US
Mailing Address - Phone:713-664-8087
Mailing Address - Fax:713-664-8078
Practice Address - Street 1:5001 BISSONNET
Practice Address - Street 2:SUITE 107
Practice Address - City:BELLAIRE
Practice Address - State:TX
Practice Address - Zip Code:77401
Practice Address - Country:US
Practice Address - Phone:713-664-8087
Practice Address - Fax:713-664-8078
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-04
Last Update Date:2008-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4164TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXX64540Medicare UPIN
TX00134SMedicare PIN
TX1314970001Medicare NSC