Healthcare Provider Details

I. General information

NPI: 1669749925
Provider Name (Legal Business Name): WEST TEXAS EYECARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2011
Last Update Date: 10/05/2020
Certification Date: 10/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

605 N MAIN ST
FORT STOCKTON TX
79735-5625
US

IV. Provider business mailing address

605 N MAIN ST
FORT STOCKTON TX
79735-5625
US

V. Phone/Fax

Practice location:
  • Phone: 432-336-3662
  • Fax: 432-336-7806
Mailing address:
  • Phone: 432-336-3662
  • Fax: 432-336-7806

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number7578TG
License Number StateTX

VIII. Authorized Official

Name: JASHUA R PASS
Title or Position: OWNER
Credential: OD
Phone: 432-336-3662