Healthcare Provider Details

I. General information

NPI: 1508063504
Provider Name (Legal Business Name): WHITNEY FAMILY EYECARE P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2007
Last Update Date: 05/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1221 N. BRAZOS STREET SUITE B
WHITNEY TX
76692
US

IV. Provider business mailing address

PO BOX 2067
WHITNEY TX
76692-5067
US

V. Phone/Fax

Practice location:
  • Phone: 254-694-3435
  • Fax: 254-694-9968
Mailing address:
  • Phone: 254-694-3435
  • Fax: 254-694-9968

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number5119TG
License Number StateTX

VIII. Authorized Official

Name: DR. LON WHITFIELD EUBANK
Title or Position: OWNER
Credential: O.D.
Phone: 254-694-3435