Provider Demographics
NPI:1003246885
Name:EBF EYE PRO, LLC
Entity type:Organization
Organization Name:EBF EYE PRO, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EMIL
Authorized Official - Middle Name:
Authorized Official - Last Name:FADEL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:512-345-5642
Mailing Address - Street 1:9595 SIX PINES DR
Mailing Address - Street 2:SUITE 1350A
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77380-1531
Mailing Address - Country:US
Mailing Address - Phone:281-298-3755
Mailing Address - Fax:
Practice Address - Street 1:9595 SIX PINES DR
Practice Address - Street 2:SUITE 1350A
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77380-1531
Practice Address - Country:US
Practice Address - Phone:281-298-3755
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-15
Last Update Date:2013-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6350152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty