Provider Demographics
NPI:1982966743
Name:BELLA VISTA EYECARE ASSOCIATES, PA
Entity Type:Organization
Organization Name:BELLA VISTA EYECARE ASSOCIATES, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:EICKHOFF
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:281-724-3040
Mailing Address - Street 1:3510 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LEAGUE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77573-1733
Mailing Address - Country:US
Mailing Address - Phone:281-724-3040
Mailing Address - Fax:281-724-3041
Practice Address - Street 1:3510 W MAIN ST
Practice Address - Street 2:
Practice Address - City:LEAGUE CITY
Practice Address - State:TX
Practice Address - Zip Code:77573-1733
Practice Address - Country:US
Practice Address - Phone:281-724-3040
Practice Address - Fax:281-724-3041
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-07
Last Update Date:2013-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7252152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB160110Medicare PIN