Provider Demographics
NPI:1821240037
Name:POOLE EYE ASSOCIATES
Entity Type:Organization
Organization Name:POOLE EYE ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MOHAN
Authorized Official - Middle Name:VALENTINO
Authorized Official - Last Name:POOLE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:512-619-0196
Mailing Address - Street 1:614 7TH ST
Mailing Address - Street 2:
Mailing Address - City:MARBLE FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:78654-5819
Mailing Address - Country:US
Mailing Address - Phone:830-693-3292
Mailing Address - Fax:830-693-8365
Practice Address - Street 1:614 7TH ST
Practice Address - Street 2:
Practice Address - City:MARBLE FALLS
Practice Address - State:TX
Practice Address - Zip Code:78654-5819
Practice Address - Country:US
Practice Address - Phone:830-693-3292
Practice Address - Fax:830-693-8365
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-21
Last Update Date:2008-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty