Provider Demographics
NPI:1770554297
Name:EAST TEXAS EYE ASSOCIATES
Entity type:Organization
Organization Name:EAST TEXAS EYE ASSOCIATES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JO
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:O'NEILL
Authorized Official - Suffix:
Authorized Official - Credentials:COT
Authorized Official - Phone:936-634-8381
Mailing Address - Street 1:1306 W FRANK AVE
Mailing Address - Street 2:
Mailing Address - City:LUFKIN
Mailing Address - State:TX
Mailing Address - Zip Code:75904-3313
Mailing Address - Country:US
Mailing Address - Phone:936-634-8381
Mailing Address - Fax:936-639-9848
Practice Address - Street 1:1306 W FRANK AVE
Practice Address - Street 2:
Practice Address - City:LUFKIN
Practice Address - State:TX
Practice Address - Zip Code:75904-3313
Practice Address - Country:US
Practice Address - Phone:936-634-8381
Practice Address - Fax:936-639-9848
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-01
Last Update Date:2015-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX210261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX127345005Medicaid
TX490001072OtherRAILROAD MEDICARE
TXHH1305OtherBLUE CROSS BLUE SHIELD
TX451097Medicare PIN
TX490001072OtherRAILROAD MEDICARE