Provider Demographics
NPI:1356383129
Name:LAYTON BROTHERS OPTICAL INC
Entity type:Organization
Organization Name:LAYTON BROTHERS OPTICAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:LAYTON
Authorized Official - Suffix:
Authorized Official - Credentials:MR
Authorized Official - Phone:361-853-2151
Mailing Address - Street 1:3636 S ALAMEDA ST
Mailing Address - Street 2:SUITE D
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78411-1723
Mailing Address - Country:US
Mailing Address - Phone:361-853-2151
Mailing Address - Fax:
Practice Address - Street 1:3636 S ALAMEDA ST
Practice Address - Street 2:SUITE D
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78411-1723
Practice Address - Country:US
Practice Address - Phone:361-853-2151
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0883680001OtherPGBA
TX513585OtherBCBS
TX0883680001OtherPGBA