Provider Demographics
NPI:1679554349
Name:SOUTH TEXAS EYE SURGICENTER INC
Entity Type:Organization
Organization Name:SOUTH TEXAS EYE SURGICENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:T
Authorized Official - Last Name:MCMAHON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:361-578-0107
Mailing Address - Street 1:4406 N LAURENT
Mailing Address - Street 2:
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77901-2791
Mailing Address - Country:US
Mailing Address - Phone:361-578-0107
Mailing Address - Fax:361-578-1320
Practice Address - Street 1:4406 N LAURENT
Practice Address - Street 2:
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77901-2791
Practice Address - Country:US
Practice Address - Phone:361-578-0107
Practice Address - Fax:361-578-1320
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-09
Last Update Date:2010-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX000144261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX085879701Medicaid
TX1679554349OtherNPI
TX085879701Medicaid