Healthcare Provider Details

I. General information

NPI: 1649450149
Provider Name (Legal Business Name): CROWN EYE CARE CENTER, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2007
Last Update Date: 11/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1618 W CHURCH ST
LIVINGSTON TX
77351-9043
US

IV. Provider business mailing address

PO BOX 1858
LIVINGSTON TX
77351-0035
US

V. Phone/Fax

Practice location:
  • Phone: 936-327-6379
  • Fax: 936-327-3599
Mailing address:
  • Phone: 936-327-6379
  • Fax: 936-326-3599

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number5938TG
License Number StateTX

VIII. Authorized Official

Name: DR. STEPHANIE MICHELE DAVIS
Title or Position: PRESIDENT
Credential: O.D.
Phone: 832-266-9346