Provider Demographics
NPI:1760424014
Name:SAN JACINTO REGIONAL EYE CENTER
Entity Type:Organization
Organization Name:SAN JACINTO REGIONAL EYE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING/INSURANCE COORDINATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:A
Authorized Official - Last Name:ZAPATA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-422-2020
Mailing Address - Street 1:4301 GARTH RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BAYTOWN
Mailing Address - State:TX
Mailing Address - Zip Code:77521-3153
Mailing Address - Country:US
Mailing Address - Phone:281-422-2020
Mailing Address - Fax:281-422-4959
Practice Address - Street 1:4301 GARTH RD
Practice Address - Street 2:SUITE 100
Practice Address - City:BAYTOWN
Practice Address - State:TX
Practice Address - Zip Code:77521-3153
Practice Address - Country:US
Practice Address - Phone:281-422-2020
Practice Address - Fax:281-422-4959
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-12
Last Update Date:2015-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX094753301Medicaid
TX094753301Medicaid