Provider Demographics
NPI:1528178779
Name:BREAUX, GREGORY MARK (OD)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:MARK
Last Name:BREAUX
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2257 N LOOP 336 W STE 150
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77304-3577
Mailing Address - Country:US
Mailing Address - Phone:936-788-2600
Mailing Address - Fax:
Practice Address - Street 1:2257 N LOOP 336 W STE 150
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77304-3577
Practice Address - Country:US
Practice Address - Phone:936-788-2600
Practice Address - Fax:936-788-2601
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2022-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6887T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist