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NPI Code Detail

MEDICARE: NACOGDOCHES EYE ASSOCIATES, PLLC

MEDICARE: NACOGDOCHES EYE ASSOCIATES, PLLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1152W00000XOptometrist06101TGTX

General Provider Information

NPI Number : 1356645964
Entity Type Code : Organization
Provider Name (Legal Business Name) : NACOGDOCHES EYE ASSOCIATES, PLLC
Provider Business Mailing Address
First Line : PO BOX 632600
Second Line :
City : NACOGDOCHES
State : TX
Zip : 75963-2600
Country : US
Telephone Number : 936-564-7661
Fax Number : 936-564-6622
Provider Business Practice Location Address
First Line : 3208 N UNIVERSITY DR
Second Line :
City : NACOGDOCHES
State : TX
Zip : 75965-2633
Country : US
Telephone Number : 936-564-7661
Fax Number : 936-564-6622
Authorized Official
Title or Position : CO OWNER
Name : DR. ASHLEY HALBERT RISNER
Credential : OD
Telephone Number : 936-564-7661
Provider Enumeration Date : 12/23/2010
Last Update Date : 12/23/2010

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