Provider Demographics
NPI:1659678761
Name:GRAHAM EYE CARE LLC
Entity Type:Organization
Organization Name:GRAHAM EYE CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:HOWELL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:940-549-1800
Mailing Address - Street 1:2200 STATE HIGHWAY 16 S
Mailing Address - Street 2:
Mailing Address - City:GRAHAM
Mailing Address - State:TX
Mailing Address - Zip Code:76450-4616
Mailing Address - Country:US
Mailing Address - Phone:940-549-1800
Mailing Address - Fax:940-549-1818
Practice Address - Street 1:2200 STATE HIGHWAY 16 S
Practice Address - Street 2:
Practice Address - City:GRAHAM
Practice Address - State:TX
Practice Address - Zip Code:76450-4616
Practice Address - Country:US
Practice Address - Phone:940-549-1800
Practice Address - Fax:940-549-1818
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-25
Last Update Date:2012-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6776TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX286228601Medicaid
TX6634630001Medicare NSC