Provider Demographics
NPI:1629253943
Name:LEVELLAND EYE AND VISION PC
Entity Type:Organization
Organization Name:LEVELLAND EYE AND VISION PC
Other - Org Name:DRS. PAYNE AND NEAL, OPTOMETRISTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:W
Authorized Official - Last Name:PAYNE
Authorized Official - Suffix:JR
Authorized Official - Credentials:OD
Authorized Official - Phone:806-894-6330
Mailing Address - Street 1:608 AUSTIN ST
Mailing Address - Street 2:
Mailing Address - City:LEVELLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79336-4616
Mailing Address - Country:US
Mailing Address - Phone:806-894-6330
Mailing Address - Fax:806-894-2443
Practice Address - Street 1:608 AUSTIN ST
Practice Address - Street 2:
Practice Address - City:LEVELLAND
Practice Address - State:TX
Practice Address - Zip Code:79336-4616
Practice Address - Country:US
Practice Address - Phone:806-894-6330
Practice Address - Fax:806-894-2443
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-05
Last Update Date:2015-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1969TG152W00000X
332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No332H00000XSuppliersEyewear SupplierGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0029QTOtherBLUE CROSS BLUE SHIELD OF TEXAS
TX193780701Medicaid
TX00Z025Medicare PIN
TX0029QTOtherBLUE CROSS BLUE SHIELD OF TEXAS