MEDICARE: SOUTH EAST TEXAS LASER EYE INSTITUTE

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
1	261Q00000X	Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0006HQ	OTHER	TX	BLUECROSSBLUE SHIELD

General Provider Information

NPI Number	:	1669402830
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTH EAST TEXAS LASER EYE INSTITUTE

Provider Business Mailing Address
First Line	:	3000 39TH ST
Second Line	:	SUITE 105
City	:	PORT ARTHUR
State	:	TX
Zip	:	77642-5517
Country	:	US
Telephone Number	:	409-985-2745
Fax Number	:	409-985-2661

Provider Business Practice Location Address
First Line	:	3000 39TH ST
Second Line	:	SUITE 105
City	:	PORT ARTHUR
State	:	TX
Zip	:	77642-5517
Country	:	US
Telephone Number	:	409-985-2745
Fax Number	:	409-985-2661

Authorized Official
Title or Position	:	OWNER
Name	:	RAJ K. SINGLA
Credential	:	M.D.
Telephone Number	:	409-985-2745

Provider Enumeration Date	:	07/04/2006
Last Update Date	:	08/22/2020

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