Provider Demographics
NPI:1619125457
Name:SEC SIGNATURE EYE CENTER, LLC
Entity Type:Organization
Organization Name:SEC SIGNATURE EYE CENTER, LLC
Other - Org Name:SIGNATURE EYE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DOCTOR, OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:VRAZEL
Authorized Official - Last Name:KOEHLER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:281-337-3344
Mailing Address - Street 1:601 E FM 646 RD STE A
Mailing Address - Street 2:
Mailing Address - City:LEAGUE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77573-7478
Mailing Address - Country:US
Mailing Address - Phone:281-337-3344
Mailing Address - Fax:281-337-3340
Practice Address - Street 1:601 E FM 646 RD STE A
Practice Address - Street 2:
Practice Address - City:LEAGUE CITY
Practice Address - State:TX
Practice Address - Zip Code:77573-7478
Practice Address - Country:US
Practice Address - Phone:281-337-3444
Practice Address - Fax:281-337-3340
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-05
Last Update Date:2023-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7215TG152W00000X
332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No332H00000XSuppliersEyewear SupplierGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00Z696Medicare PIN
TX6370320001Medicare NSC