Provider Demographics
NPI:1710102280
Name:PINEYWOODS EYE ASSOCIATES P A
Entity Type:Organization
Organization Name:PINEYWOODS EYE ASSOCIATES P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:D
Authorized Official - Last Name:GOLDEN
Authorized Official - Suffix:
Authorized Official - Credentials:O D
Authorized Official - Phone:936-564-2634
Mailing Address - Street 1:PO BOX 1838
Mailing Address - Street 2:
Mailing Address - City:CENTER
Mailing Address - State:TX
Mailing Address - Zip Code:75935-1838
Mailing Address - Country:US
Mailing Address - Phone:936-564-2634
Mailing Address - Fax:936-564-0387
Practice Address - Street 1:4729 NE STALLINGS DR
Practice Address - Street 2:
Practice Address - City:NACOGDOCHES
Practice Address - State:TX
Practice Address - Zip Code:75965-1607
Practice Address - Country:US
Practice Address - Phone:936-564-2634
Practice Address - Fax:936-564-0387
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2023-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1140160001Medicare NSC