Provider Demographics
NPI:1770707853
Name:TOTAL EYE CARE, PA
Entity type:Organization
Organization Name:TOTAL EYE CARE, PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/BILLING
Authorized Official - Prefix:DR
Authorized Official - First Name:YVONNE
Authorized Official - Middle Name:
Authorized Official - Last Name:JENKINS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:281-373-1020
Mailing Address - Street 1:12320 BARKER CYPRESS RD
Mailing Address - Street 2:STE 400
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77429-8325
Mailing Address - Country:US
Mailing Address - Phone:281-373-1020
Mailing Address - Fax:281-373-1695
Practice Address - Street 1:12320 BARKER CYPRESS RD
Practice Address - Street 2:STE 400
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77429-8325
Practice Address - Country:US
Practice Address - Phone:281-373-1020
Practice Address - Fax:281-373-1695
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-12
Last Update Date:2012-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5754TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX156338901Medicaid
TX156338901Medicaid
TX4532070001Medicare NSC