Provider Demographics
NPI:1710493838
Name:VARDEMAN EYE ASSOCIATES PLLC
Entity Type:Organization
Organization Name:VARDEMAN EYE ASSOCIATES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF OPTOMETERY/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MELANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:VARDEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:936-560-2020
Mailing Address - Street 1:3915 NE STALLINGS DR
Mailing Address - Street 2:
Mailing Address - City:NACOGDOCHES
Mailing Address - State:TX
Mailing Address - Zip Code:75965-2169
Mailing Address - Country:US
Mailing Address - Phone:936-560-2020
Mailing Address - Fax:936-564-9696
Practice Address - Street 1:3915 NE STALLINGS DR
Practice Address - Street 2:
Practice Address - City:NACOGDOCHES
Practice Address - State:TX
Practice Address - Zip Code:75965-2169
Practice Address - Country:US
Practice Address - Phone:936-560-2020
Practice Address - Fax:936-564-9696
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-27
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX166958908OtherINDIVIDUAL NPI
166958908OtherINDIVIDUAL NPI