Provider Demographics
NPI:1558645879
Name:EAGLE EYE CENTER BELLAIRE LLC
Entity Type:Organization
Organization Name:EAGLE EYE CENTER BELLAIRE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:YAQUN
Authorized Official - Middle Name:
Authorized Official - Last Name:BAO
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:713-270-9188
Mailing Address - Street 1:9188 BELLAIRE BLVD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77036-4623
Mailing Address - Country:US
Mailing Address - Phone:713-270-9188
Mailing Address - Fax:713-271-9188
Practice Address - Street 1:9188 BELLAIRE BLVD
Practice Address - Street 2:SUITE 1
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77036-4623
Practice Address - Country:US
Practice Address - Phone:713-270-9188
Practice Address - Fax:713-271-9188
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-05
Last Update Date:2011-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6480TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX6480TGOtherTEXAS OPTOMETRY LICENSE