Provider Demographics
NPI:1639585938
Name:LOVENS CRYSTAL CLEAR EYE CARE PLLC
Entity Type:Organization
Organization Name:LOVENS CRYSTAL CLEAR EYE CARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TRAVIS
Authorized Official - Middle Name:M
Authorized Official - Last Name:LOVEN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:254-666-8900
Mailing Address - Street 1:10008 ADOBE CT
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76712-8961
Mailing Address - Country:US
Mailing Address - Phone:254-666-8900
Mailing Address - Fax:254-666-2888
Practice Address - Street 1:600 HEWITT DR
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76712-6654
Practice Address - Country:US
Practice Address - Phone:254-666-8900
Practice Address - Fax:254-666-2888
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-08
Last Update Date:2014-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6897TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX210573602Medicaid
TX210573602Medicaid