Provider Demographics
NPI:1750659413
Name:TEXARKANA EYE ASSOCIATES
Entity Type:Organization
Organization Name:TEXARKANA EYE ASSOCIATES
Other - Org Name:MT. PLEASANT EYE ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:INSURANCE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:AUDREY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:FELTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-838-0783
Mailing Address - Street 1:2703 RICHMOND RD
Mailing Address - Street 2:
Mailing Address - City:TEXARKANA
Mailing Address - State:TX
Mailing Address - Zip Code:75503-2328
Mailing Address - Country:US
Mailing Address - Phone:903-838-0783
Mailing Address - Fax:903-831-6145
Practice Address - Street 1:1606 S JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:TX
Practice Address - Zip Code:75455-5614
Practice Address - Country:US
Practice Address - Phone:903-838-0783
Practice Address - Fax:903-831-6145
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-09
Last Update Date:2012-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7424152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00E39YMedicare PIN