Provider Demographics
NPI:1932181641
Name:SOUTH TEXAS EYE ASSOCIATES
Entity Type:Organization
Organization Name:SOUTH TEXAS EYE ASSOCIATES
Other - Org Name:SOUTH TEXAS EYE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:T
Authorized Official - Last Name:MCMAHON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:361-578-0107
Mailing Address - Street 1:4406 N LAURENT
Mailing Address - Street 2:
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77901-2791
Mailing Address - Country:US
Mailing Address - Phone:361-578-0107
Mailing Address - Fax:361-578-1320
Practice Address - Street 1:4406 N LAURENT
Practice Address - Street 2:
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77901-2791
Practice Address - Country:US
Practice Address - Phone:361-578-0107
Practice Address - Fax:361-578-1320
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-17
Last Update Date:2010-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1932181641OtherNPI
TX157270301Medicaid
TX1932181641OtherNPI
TX0880170001Medicare NSC