Provider Demographics
NPI:1609828839
Name:TSO OF GAINESVILLE INC
Entity type:Organization
Organization Name:TSO OF GAINESVILLE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:A
Authorized Official - Last Name:WEBB
Authorized Official - Suffix:JR
Authorized Official - Credentials:OD
Authorized Official - Phone:940-668-7500
Mailing Address - Street 1:311 E CALIFORNIA ST
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76240-4005
Mailing Address - Country:US
Mailing Address - Phone:940-668-7500
Mailing Address - Fax:940-665-7377
Practice Address - Street 1:311 E CALIFORNIA ST
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:TX
Practice Address - Zip Code:76240-4005
Practice Address - Country:US
Practice Address - Phone:940-668-7500
Practice Address - Fax:940-665-7377
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-16
Last Update Date:2010-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2497TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX207866901Medicaid
TX112448901Medicaid
TX0641500001Medicare NSC
TX112448901Medicaid
TX0A3797Medicare PIN