Healthcare Provider Details

I. General information

NPI: 1760424014
Provider Name (Legal Business Name): SAN JACINTO REGIONAL EYE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2006
Last Update Date: 01/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4301 GARTH RD SUITE 100
BAYTOWN TX
77521-3153
US

IV. Provider business mailing address

4301 GARTH RD SUITE 100
BAYTOWN TX
77521-3153
US

V. Phone/Fax

Practice location:
  • Phone: 281-422-2020
  • Fax: 281-422-4959
Mailing address:
  • Phone: 281-422-2020
  • Fax: 281-422-4959

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: MRS. MARIA A ZAPATA
Title or Position: BILLING/INSURANCE COORDINATOR
Credential:
Phone: 281-422-2020