Provider Demographics
NPI:1598261919
Name:JAMES CITEK OD PLLC
Entity Type:Organization
Organization Name:JAMES CITEK OD PLLC
Other - Org Name:COASTAL OPITCAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:F
Authorized Official - Last Name:CITEK
Authorized Official - Suffix:
Authorized Official - Credentials:ODD
Authorized Official - Phone:979-849-2331
Mailing Address - Street 1:1818 N VELASCO ST
Mailing Address - Street 2:
Mailing Address - City:ANGLETON
Mailing Address - State:TX
Mailing Address - Zip Code:77515-3015
Mailing Address - Country:US
Mailing Address - Phone:979-849-2331
Mailing Address - Fax:979-849-7520
Practice Address - Street 1:1818 N VELASCO ST
Practice Address - Street 2:
Practice Address - City:ANGLETON
Practice Address - State:TX
Practice Address - Zip Code:77515-3015
Practice Address - Country:US
Practice Address - Phone:979-849-2331
Practice Address - Fax:979-849-7520
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-04
Last Update Date:2018-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2698TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX742638006Medicaid