MEDICARE: PINEYWOODS EYE ASSOCIATES P A

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	332H00000X	Eyewear Supplier

General Provider Information

NPI Number	:	1710102280
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PINEYWOODS EYE ASSOCIATES P A

Provider Business Mailing Address
First Line	:	PO BOX 1838
Second Line	:
City	:	CENTER
State	:	TX
Zip	:	75935-1838
Country	:	US
Telephone Number	:	936-564-2634
Fax Number	:	936-564-0387

Provider Business Practice Location Address
First Line	:	4729 NE STALLINGS DR
Second Line	:
City	:	NACOGDOCHES
State	:	TX
Zip	:	75965-1607
Country	:	US
Telephone Number	:	936-564-2634
Fax Number	:	936-564-0387

Authorized Official
Title or Position	:	OWNER
Name	:	DAVID D GOLDEN
Credential	:	O. D.
Telephone Number	:	936-564-2634

Provider Enumeration Date	:	04/17/2007
Last Update Date	:	05/08/2023

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