Healthcare Provider Details

I. General information

NPI: 1811954100
Provider Name (Legal Business Name): COLUMBUS EYE ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/28/2006
Last Update Date: 11/30/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 SWEETBRIAR DR
COLUMBUS TX
78934-3008
US

IV. Provider business mailing address

100 SWEETBRIAR DR
COLUMBUS TX
78934-3008
US

V. Phone/Fax

Practice location:
  • Phone: 979-732-5771
  • Fax: 979-732-6922
Mailing address:
  • Phone: 979-732-5771
  • Fax: 979-732-6922

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State

VIII. Authorized Official

Name: BOB D. MOORE
Title or Position: ADMINISTRATOR
Credential:
Phone: 979-732-5771