Provider Demographics
NPI:1841399722
Name:TEXAN EYE, PA
Entity Type:Organization
Organization Name:TEXAN EYE, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PATIENT ACCOUNT MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERTA
Authorized Official - Middle Name:M
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-314-1632
Mailing Address - Street 1:5717 BALCONES DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78731-4203
Mailing Address - Country:US
Mailing Address - Phone:512-327-7000
Mailing Address - Fax:512-314-1662
Practice Address - Street 1:85 LOOP 150 WEST
Practice Address - Street 2:
Practice Address - City:BASTROP
Practice Address - State:TX
Practice Address - Zip Code:78602
Practice Address - Country:US
Practice Address - Phone:512-303-7300
Practice Address - Fax:512-303-2148
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TEXAN EYE, PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-09-21
Last Update Date:2020-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG3889152W00000X, 207W00000X, 332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
No332H00000XSuppliersEyewear SupplierGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX085574301Medicaid
TX085574301Medicaid
SC0922210004Medicare NSC