Provider Demographics
NPI:1508959354
Name:GEORGE W. PAYNE, JR. O.D.
Entity Type:Organization
Organization Name:GEORGE W. PAYNE, JR. O.D.
Other - Org Name:DR. PAYNE AND DR. NEAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:W
Authorized Official - Last Name:PAYNE
Authorized Official - Suffix:JR
Authorized Official - Credentials:OD
Authorized Official - Phone:806-894-6330
Mailing Address - Street 1:608 AUSTIN STREET
Mailing Address - Street 2:
Mailing Address - City:LEVELLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79336-4616
Mailing Address - Country:US
Mailing Address - Phone:806-894-6330
Mailing Address - Fax:806-894-2443
Practice Address - Street 1:608 AUSTIN STREET
Practice Address - Street 2:
Practice Address - City:LEVELLAND
Practice Address - State:TX
Practice Address - Zip Code:79336-4616
Practice Address - Country:US
Practice Address - Phone:806-894-6330
Practice Address - Fax:806-894-2443
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1969TG152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00E33COtherBLUE CROSS BLUE SHEILD
TX00E33CMedicare ID - Type Unspecified
TX00E33COtherBLUE CROSS BLUE SHEILD