Provider Demographics
NPI:1396876967
Name:LEVELLAND EYE AND VISION PC
Entity type:Organization
Organization Name:LEVELLAND EYE AND VISION PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:W
Authorized Official - Last Name:PAYNE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:806-894-6330
Mailing Address - Street 1:608 AUSTIN ST
Mailing Address - Street 2:
Mailing Address - City:LEVELLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79336-4616
Mailing Address - Country:US
Mailing Address - Phone:806-894-6330
Mailing Address - Fax:806-894-2443
Practice Address - Street 1:608 AUSTIN ST
Practice Address - Street 2:
Practice Address - City:LEVELLAND
Practice Address - State:TX
Practice Address - Zip Code:79336-4616
Practice Address - Country:US
Practice Address - Phone:806-894-6330
Practice Address - Fax:806-894-2443
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-08
Last Update Date:2015-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332H00000XSuppliersEyewear Supplier
No152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX193780701Medicaid
TX6018380001Medicare NSC
TX00X979Medicare UPIN