Provider Demographics
NPI:1982780615
Name:TEXOMA FAMILY EYE CARE CLINIC PA
Entity Type:Organization
Organization Name:TEXOMA FAMILY EYE CARE CLINIC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LEEANN
Authorized Official - Middle Name:
Authorized Official - Last Name:MOLL-LEAR
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:940-696-9072
Mailing Address - Street 1:4102 JACKSBORO HWY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76302-2747
Mailing Address - Country:US
Mailing Address - Phone:940-696-9072
Mailing Address - Fax:940-761-1115
Practice Address - Street 1:4102 JACKSBORO HWY
Practice Address - Street 2:SUITE 100
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76302-2747
Practice Address - Country:US
Practice Address - Phone:940-696-9072
Practice Address - Fax:940-761-1115
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-27
Last Update Date:2008-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3892T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8F0247OtherREFERRING PROVIDER ID
TX0933137-01Medicaid
TXMO001348245OtherHIGHMARK BCBS/ALCOA
TX0022FCOtherBLUE CROSS BLUE SHIELD
TXMO001348245OtherHIGHMARK BCBS/ALCOA
TX00925YMedicare ID - Type Unspecified
TX0022FCOtherBLUE CROSS BLUE SHIELD