Provider Demographics
NPI:1609047547
Name:EYECARE PROFESSIONALS, PA
Entity type:Organization
Organization Name:EYECARE PROFESSIONALS, PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANH
Authorized Official - Middle Name:DIEU
Authorized Official - Last Name:DOAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD PA
Authorized Official - Phone:281-261-2647
Mailing Address - Street 1:4725 HIGHWAY 6
Mailing Address - Street 2:
Mailing Address - City:MISSOURI CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77459-3988
Mailing Address - Country:US
Mailing Address - Phone:281-261-2647
Mailing Address - Fax:281-499-8456
Practice Address - Street 1:4725 HIGHWAY 6
Practice Address - Street 2:
Practice Address - City:MISSOURI CITY
Practice Address - State:TX
Practice Address - Zip Code:77459-3988
Practice Address - Country:US
Practice Address - Phone:281-261-2647
Practice Address - Fax:281-499-8456
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-19
Last Update Date:2014-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4635TG152W00000X, 152WC0802X, 152WP0200X, 152WS0006X, 152WX0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Single Specialty
No152WP0200XEye and Vision Services ProvidersOptometristPediatricsGroup - Single Specialty
No152WS0006XEye and Vision Services ProvidersOptometristSports VisionGroup - Single Specialty
No152WX0102XEye and Vision Services ProvidersOptometristOccupational VisionGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0019FEOtherBLUE CROSS BLUE SHIELD
TX3366794OtherAETNA
TX00867VMedicare PIN