Provider Demographics
NPI:1740382258
Name:AUGUSTINE K. MABATAH
Entity Type:Organization
Organization Name:AUGUSTINE K. MABATAH
Other - Org Name:QUALITY EYE CARE CLINICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:AUGUSTINE
Authorized Official - Middle Name:KANEBI
Authorized Official - Last Name:MABATAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-635-5177
Mailing Address - Street 1:8300 HOMESTEAD RD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77028-2145
Mailing Address - Country:US
Mailing Address - Phone:713-635-5177
Mailing Address - Fax:713-631-8242
Practice Address - Street 1:8300 HOMESTEAD RD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77028-2145
Practice Address - Country:US
Practice Address - Phone:713-635-5177
Practice Address - Fax:713-631-8242
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-04
Last Update Date:2008-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ1540207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX083557101Medicaid
TX0937380001Medicare NSC
TX083557101Medicaid