Healthcare Provider Details

I. General information

NPI: 1659851277
Provider Name (Legal Business Name): EYE CENTER OF JASPER, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2018
Last Update Date: 08/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

617 E GIBSON ST
JASPER TX
75951-5105
US

IV. Provider business mailing address

5300 NORTH ST
NACOGDOCHES TX
75965-1370
US

V. Phone/Fax

Practice location:
  • Phone: 409-381-8100
  • Fax: 409-381-8101
Mailing address:
  • Phone: 936-569-8278
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State

VIII. Authorized Official

Name: ROBERT PAUL LEHMANN
Title or Position: PARTNER
Credential: MD
Phone: 936-569-8278