Provider Demographics
NPI:1912303074
Name:CONROE EYES
Entity Type:Organization
Organization Name:CONROE EYES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:
Authorized Official - Last Name:PHAM
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:832-948-8885
Mailing Address - Street 1:2104 N FRAZIER ST STE H
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77301-1250
Mailing Address - Country:US
Mailing Address - Phone:936-202-3043
Mailing Address - Fax:281-298-8533
Practice Address - Street 1:10807 KUYKENDAHL RD STE 408
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77382-2782
Practice Address - Country:US
Practice Address - Phone:281-298-8332
Practice Address - Fax:281-298-8533
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-17
Last Update Date:2014-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7244152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty