Provider Demographics
NPI:1891971735
Name:PARK CENTRAL EYECARE PA
Entity Type:Organization
Organization Name:PARK CENTRAL EYECARE PA
Other - Org Name:MASTER EYE PORT ARTHUR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CONNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:UNG
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:409-727-5366
Mailing Address - Street 1:2211 VILLAGE DALE AVE
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77059-3591
Mailing Address - Country:US
Mailing Address - Phone:409-727-5366
Mailing Address - Fax:409-727-4910
Practice Address - Street 1:3100 HIGHWAY 365
Practice Address - Street 2:
Practice Address - City:PORT ARTHUR
Practice Address - State:TX
Practice Address - Zip Code:77642-7724
Practice Address - Country:US
Practice Address - Phone:409-727-5366
Practice Address - Fax:409-727-4910
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-10
Last Update Date:2008-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5283TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty