Provider Demographics
NPI:1982806626
Name:BEAUMONT FAMILY EYE CARE PA
Entity Type:Organization
Organization Name:BEAUMONT FAMILY EYE CARE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER OF COMPANY
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:J
Authorized Official - Last Name:CASS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:409-832-4136
Mailing Address - Street 1:6725 DELAWARE ST
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77706-7655
Mailing Address - Country:US
Mailing Address - Phone:409-832-4136
Mailing Address - Fax:409-835-3623
Practice Address - Street 1:6725 DELAWARE ST
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77706-7655
Practice Address - Country:US
Practice Address - Phone:409-832-4136
Practice Address - Fax:409-835-3623
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-04
Last Update Date:2011-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5974TG152WV0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WV0400XEye and Vision Services ProvidersOptometristVision TherapyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0011FCOtherBLUECROSSBLUESHIELD OF TX
TX148312502Medicaid
TX7775479OtherAETNA
TX9298701005OtherCIGNA
TX4878570001Medicare NSC
TX00917UMedicare PIN
TX9298701005OtherCIGNA
TX0A5771Medicare PIN