SURGICAL EYE ASSOCIATES PA

Provider Demographics

• NPI: 1801013685
• Name: SURGICAL EYE ASSOCIATES PA
• Entity type: Organization
• Organization Name: SURGICAL EYE ASSOCIATES PA
• Authorized Official - Title/Position: OWNER
• Authorized Official - Prefix: DR
• Authorized Official - First Name: PETER
• Authorized Official - Middle Name: SUTHERLAND
• Authorized Official - Last Name: DAWSON
• Authorized Official - Credentials: MD
• Authorized Official - Phone: 713-869-6400
• Mailing Address - Street 1: 1631 NORTH LOOP WEST
• Mailing Address - Street 2: SUITE 500
• Mailing Address - City: HOUSTON
• Mailing Address - State: TX
• Mailing Address - Zip Code: 77008
• Mailing Address - Country: US
• Mailing Address - Phone: 713-869-6400
• Mailing Address - Fax: 713-802-0691
• Practice Address - Street 1: 1229 CAMPBELL RD
• Practice Address - City: HOUSTON
• Practice Address - State: TX
• Practice Address - Zip Code: 77055
• Practice Address - Country: US
• Practice Address - Phone: 713-467-6600
• Practice Address - Fax: 713-467-7914
• EIN: <UNAVAIL>
• Is Organization Subpart?: No
• Enumeration Date: 2007-04-20
• Last Update Date: 2008-05-16

Provider Licenses

State	License ID	Taxonomies
TX	05253T	152W00000X
TX	03629TG	152W00000X
TX	F0436	207W00000X
TX	G8431	207W00000X
TX	G2587	207W00000X
TX	1048950003	332H00000X

Provider Taxonomies

Primary?	Code	Type	Classification	Specialization	Group
Yes	332H00000X	Suppliers	Eyewear Supplier
No	152W00000X	Eye and Vision Services Providers	Optometrist		Group - Single Specialty
No	207W00000X	Allopathic & Osteopathic Physicians	Ophthalmology		Group - Single Specialty

Provider Identifiers

State	Identifier ID	ID Type	Issuer
TX	139414003	Medicaid
TX	114542701	Medicaid
TX	083903701	Medicaid
TX	104405902	Medicaid
TX	093137404	Medicaid
TX	G74421	Medicare UPIN
TX	139414003	Medicaid
TX	00L99S	Medicare PIN
TX	C20494	Medicare UPIN
TX	88092J	Medicare PIN
TX	104405902	Medicaid
TX	8A6253	Medicare PIN
TX	8D7053	Medicare PIN
TX	T96235	Medicare UPIN
TX	083903701	Medicaid
TX	8A2093	Medicare PIN
TX	U63893	Medicare UPIN
TX	C15099	Medicare UPIN
TX	093137404	Medicaid