MEDICARE: EYECARE PROFESSIONALS, PA

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	152WC0802X	Corneal and Contact Management Optometrist	4635TG	TX
2	152WP0200X	Pediatric Optometrist	4635TG	TX
3	152WS0006X	Sports Vision Optometrist	4635TG	TX
4	152WX0102X	Occupational Vision Optometrist	4635TG	TX
5	152W00000X	Optometrist	4635TG	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0019FE	OTHER	TX	BLUE CROSS BLUE SHIELD
2	3366794	OTHER	TX	AETNA

General Provider Information

NPI Number	:	1609047547
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EYECARE PROFESSIONALS, PA

Provider Business Mailing Address
First Line	:	4725 HIGHWAY 6
Second Line	:
City	:	MISSOURI CITY
State	:	TX
Zip	:	77459-3988
Country	:	US
Telephone Number	:	281-261-2647
Fax Number	:	281-499-8456

Provider Business Practice Location Address
First Line	:	4725 HIGHWAY 6
Second Line	:
City	:	MISSOURI CITY
State	:	TX
Zip	:	77459-3988
Country	:	US
Telephone Number	:	281-261-2647
Fax Number	:	281-499-8456

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. ANH DIEU DOAN
Credential	:	O.D PA
Telephone Number	:	281-261-2647

Provider Enumeration Date	:	03/19/2008
Last Update Date	:	01/24/2014

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Directions to “EYECARE PROFESSIONALS, PA ” Practice Location

Language	Start Address	Practice Location

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