MEDICARE: EYE CENTER OF JASPER, PLLC

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	207W00000X	Ophthalmology Physician
2	152W00000X	Optometrist

General Provider Information

NPI Number	:	1659851277
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EYE CENTER OF JASPER, PLLC

Provider Business Mailing Address
First Line	:	5300 NORTH ST
Second Line	:
City	:	NACOGDOCHES
State	:	TX
Zip	:	75965-1370
Country	:	US
Telephone Number	:	936-569-8278
Fax Number	:

Provider Business Practice Location Address
First Line	:	617 E GIBSON ST
Second Line	:
City	:	JASPER
State	:	TX
Zip	:	75951-5105
Country	:	US
Telephone Number	:	409-381-8100
Fax Number	:	409-381-8101

Authorized Official
Title or Position	:	PARTNER
Name	:	ROBERT PAUL LEHMANN
Credential	:	MD
Telephone Number	:	936-569-8278

Provider Enumeration Date	:	08/14/2018
Last Update Date	:	08/14/2018

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