MEDICARE: BROWNSVILLE EYE CENTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QS0132X	Ophthalmologic Surgery Clinic/Center
2	152W00000X	Optometrist

General Provider Information

NPI Number	:	1437783586
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BROWNSVILLE EYE CENTER

Provider Business Mailing Address
First Line	:	749 S RIVER RD
Second Line	:
City	:	SAINT GEORGE
State	:	UT
Zip	:	84790-5509
Country	:	US
Telephone Number	:	435-628-4464
Fax Number	:

Provider Business Practice Location Address
First Line	:	2200 BOCA CHICA BLVD STE 106
Second Line	:
City	:	BROWNSVILLE
State	:	TX
Zip	:	78521-2241
Country	:	US
Telephone Number	:	956-214-5018
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	TREVOR HAMMONS
Credential	:	OD
Telephone Number	:	435-628-4464

Provider Enumeration Date	:	02/27/2020
Last Update Date	:	02/27/2020

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