Provider Demographics
NPI:1518139740
Name:SMGS PC
Entity Type:Organization
Organization Name:SMGS PC
Other - Org Name:BAY COLONY EYECARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SERITA
Authorized Official - Middle Name:M
Authorized Official - Last Name:GARDNER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:281-309-9700
Mailing Address - Street 1:2945 GULF FWY S STE C
Mailing Address - Street 2:
Mailing Address - City:LEAGUE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77573-6771
Mailing Address - Country:US
Mailing Address - Phone:281-309-9700
Mailing Address - Fax:281-309-9720
Practice Address - Street 1:2945 GULF FWY S STE C
Practice Address - Street 2:
Practice Address - City:LEAGUE CITY
Practice Address - State:TX
Practice Address - Zip Code:77573-6771
Practice Address - Country:US
Practice Address - Phone:281-309-9700
Practice Address - Fax:281-309-9720
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-27
Last Update Date:2008-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4258T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX103821Medicaid
TX81302QOtherBCBS
TX103821Medicaid