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General NPI Number Information
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NPI Number | 1124003454
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Entity Type | Organization
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Legal Business Name | EYE CENTERS OF SOUTHEAST TEXAS LLP
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Dates
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Enumeration Date | 12/09/2005
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Last Update Date | 10/29/2024
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Provider Practice Location Address
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Address Line | 3345 PLAZA 10 DR SUITE B
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City | BEAUMONT
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State | TX
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Zip | 77707-2554
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Country | US
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Telephone | 409-833-0444
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Fax | 409-833-9039
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Provider Business Mailing Address
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Address Line | PO BOX 7160
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City | BEAUMONT
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State | TX
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Zip | 77726-7160
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Country | US
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Telephone | 409-833-0444
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Fax | 409-833-9039
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Authorized Official
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Title or Position | CHIEF FINANCIAL OFFICER
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Name | MRS. SANDRA J MELTON
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Credential |
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Telephone | 409-833-0444
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number |
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License Number State | TX
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