Provider Demographics
NPI:1720376049
Name:CAMERON OPTICAL PLLC
Entity Type:Organization
Organization Name:CAMERON OPTICAL PLLC
Other - Org Name:FOREYEZ
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BONNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:CAMERON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:936-448-1200
Mailing Address - Street 1:15260 HIGHWAY 105 W
Mailing Address - Street 2:STE. 127
Mailing Address - City:MONTGOMERY
Mailing Address - State:TX
Mailing Address - Zip Code:77356-5273
Mailing Address - Country:US
Mailing Address - Phone:936-448-1200
Mailing Address - Fax:936-582-1211
Practice Address - Street 1:15260 HIGHWAY 105 W
Practice Address - Street 2:STE. 127
Practice Address - City:MONTGOMERY
Practice Address - State:TX
Practice Address - Zip Code:77356-5273
Practice Address - Country:US
Practice Address - Phone:936-448-1200
Practice Address - Fax:936-582-1211
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-20
Last Update Date:2017-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7042TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB131149Medicare PIN