Provider Demographics
NPI:1811954100
Name:COLUMBUS EYE ASSOCIATES
Entity type:Organization
Organization Name:COLUMBUS EYE ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:BOB
Authorized Official - Middle Name:D
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:979-732-5771
Mailing Address - Street 1:100 SWEETBRIAR DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:TX
Mailing Address - Zip Code:78934-3008
Mailing Address - Country:US
Mailing Address - Phone:979-732-5771
Mailing Address - Fax:979-732-6922
Practice Address - Street 1:100 SWEETBRIAR DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:TX
Practice Address - Zip Code:78934-3008
Practice Address - Country:US
Practice Address - Phone:979-732-5771
Practice Address - Fax:979-732-6922
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-28
Last Update Date:2010-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX081861903Medicaid
TX081861902Medicaid
TX081861903Medicaid
TX081861902Medicaid