Provider Demographics
NPI:1649450149
Name:CROWN EYE CARE CENTER, P.C.
Entity type:Organization
Organization Name:CROWN EYE CARE CENTER, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:MICHELE
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:832-266-9346
Mailing Address - Street 1:PO BOX 1858
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77351-0035
Mailing Address - Country:US
Mailing Address - Phone:936-327-6379
Mailing Address - Fax:936-326-3599
Practice Address - Street 1:1618 W CHURCH ST
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:TX
Practice Address - Zip Code:77351-9043
Practice Address - Country:US
Practice Address - Phone:936-327-6379
Practice Address - Fax:936-327-3599
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-13
Last Update Date:2008-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5938TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0096QTOtherBLUE CROSS BLUE SHIELD
TX00Z089Medicare PIN