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General NPI Number Information
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NPI Number | 1457385551
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Entity Type | Organization
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Legal Business Name | EAST TEXAS EYE CENTER PA
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Dates
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Enumeration Date | 07/11/2006
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Last Update Date | 05/05/2015
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Provider Practice Location Address
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Address Line | 901 E HOUSTON ST STE B
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City | CLEVELAND
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State | TX
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Zip | 77327-4602
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Country | US
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Telephone | 281-659-2020
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Fax | 281-659-2030
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Provider Business Mailing Address
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Address Line | 18700 W LAKE HOUSTON PKWY STE B101
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City | HUMBLE
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State | TX
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Zip | 77346-3349
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Country | US
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Telephone | 281-812-4000
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Fax | 281-812-3331
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. K RAY SHRUM
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Credential | MD
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Telephone | 281-659-2020
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 02830TG
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | L2649
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License Number State | TX
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