Provider Demographics
NPI:1689785560
Name:BAYSHORE OPTICAL COMPANY
Entity Type:Organization
Organization Name:BAYSHORE OPTICAL COMPANY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D.
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:M
Authorized Official - Last Name:HOLLAND
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-944-4828
Mailing Address - Street 1:3320 PLAINVIEW ST
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:TX
Mailing Address - Zip Code:77504-1906
Mailing Address - Country:US
Mailing Address - Phone:713-944-4828
Mailing Address - Fax:713-944-1401
Practice Address - Street 1:3320 PLAINVIEW ST
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:TX
Practice Address - Zip Code:77504-1906
Practice Address - Country:US
Practice Address - Phone:713-944-4828
Practice Address - Fax:713-944-1401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0041DGOtherBLUE CROSS BLUE SHIELD
0991490001OtherPALMETTO
00498EMedicare ID - Type Unspecified