Provider Demographics
NPI:1720026719
Name:THE EYE GROUP OF TEXAS LLC
Entity Type:Organization
Organization Name:THE EYE GROUP OF TEXAS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LENA
Authorized Official - Middle Name:WF
Authorized Official - Last Name:CHU
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:817-310-3989
Mailing Address - Street 1:3105 E SOUTHLAKE BLVD
Mailing Address - Street 2:
Mailing Address - City:SOUTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76092-6621
Mailing Address - Country:US
Mailing Address - Phone:817-310-3989
Mailing Address - Fax:817-346-6998
Practice Address - Street 1:3105 E SOUTHLAKE BLVD
Practice Address - Street 2:
Practice Address - City:SOUTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76092-6621
Practice Address - Country:US
Practice Address - Phone:817-310-3989
Practice Address - Fax:817-346-6998
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3413TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00E47LMedicare ID - Type Unspecified
TXU02271Medicare UPIN