Provider Demographics
NPI:1881842367
Name:MT PLEASANT EYE CARE CENTER PA
Entity Type:Organization
Organization Name:MT PLEASANT EYE CARE CENTER PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:K
Authorized Official - Last Name:NICHOLS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:903-572-4718
Mailing Address - Street 1:2001 W FERGUSON RD
Mailing Address - Street 2:SUITE 2020
Mailing Address - City:MT PLEASANT
Mailing Address - State:TX
Mailing Address - Zip Code:75455-2925
Mailing Address - Country:US
Mailing Address - Phone:903-572-1991
Mailing Address - Fax:903-572-4718
Practice Address - Street 1:2001 W FERGUSON RD
Practice Address - Street 2:SUITE 2020
Practice Address - City:MT PLEASANT
Practice Address - State:TX
Practice Address - Zip Code:75455-2925
Practice Address - Country:US
Practice Address - Phone:903-572-1991
Practice Address - Fax:903-572-4718
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-08
Last Update Date:2009-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX199333901Medicaid
TX6195690001Medicare NSC
TXU67320Medicare UPIN
TX199333901Medicaid