Provider Demographics
NPI:1841416252
Name:EAST TEXAS EYE ASSOCIATES
Entity Type:Organization
Organization Name:EAST TEXAS EYE ASSOCIATES
Other - Org Name:EAST TEXAS EYE ASSOCIATES OPTICAL SHOP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:EVERETT
Authorized Official - Last Name:DUNCAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:936-634-8381
Mailing Address - Street 1:1306 W FRANK AVE
Mailing Address - Street 2:
Mailing Address - City:LUFKIN
Mailing Address - State:TX
Mailing Address - Zip Code:75904-3313
Mailing Address - Country:US
Mailing Address - Phone:936-634-8381
Mailing Address - Fax:936-639-9848
Practice Address - Street 1:1306 W FRANK AVE
Practice Address - Street 2:
Practice Address - City:LUFKIN
Practice Address - State:TX
Practice Address - Zip Code:75904-3313
Practice Address - Country:US
Practice Address - Phone:936-634-8381
Practice Address - Fax:936-639-9848
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EAST TEXAS EYE ASSOCIATES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-04-17
Last Update Date:2018-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX127345006Medicaid
TX0683710001Medicare NSC