Provider Demographics
NPI:1861845307
Name:GAINESVILLE EYE CARE
Entity Type:Organization
Organization Name:GAINESVILLE EYE CARE
Other - Org Name:TEXAS STATE OPTICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OD / OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:WARREN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:940-218-8180
Mailing Address - Street 1:9499 CULP BRANCH RD
Mailing Address - Street 2:
Mailing Address - City:SANGER
Mailing Address - State:TX
Mailing Address - Zip Code:76266-6975
Mailing Address - Country:US
Mailing Address - Phone:940-218-8180
Mailing Address - Fax:
Practice Address - Street 1:311 E CALIFORNIA ST
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:TX
Practice Address - Zip Code:76240-4036
Practice Address - Country:US
Practice Address - Phone:940-668-7254
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-20
Last Update Date:2016-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7165TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX196451202Medicaid
TX7109TGOtherSTATE LICENSE
TX196450402Medicaid
8F7640OtherMEDICARE #
TX7165TGOtherSTATE LICENSE
8F6739OtherMEDICARE #