Healthcare Provider Details

I. General information

NPI: 1508959354
Provider Name (Legal Business Name): GEORGE W. PAYNE, JR. O.D.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

608 AUSTIN STREET
LEVELLAND TX
79336-4616
US

IV. Provider business mailing address

608 AUSTIN STREET
LEVELLAND TX
79336-4616
US

V. Phone/Fax

Practice location:
  • Phone: 806-894-6330
  • Fax: 806-894-2443
Mailing address:
  • Phone: 806-894-6330
  • Fax: 806-894-2443

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number1969TG
License Number StateTX

VIII. Authorized Official

Name: DR. GEORGE W PAYNE JR.
Title or Position: OWNER
Credential: O.D.
Phone: 806-894-6330