Provider Demographics
NPI:1538178157
Name:BROOKWOOD EYECARE, INC.
Entity type:Organization
Organization Name:BROOKWOOD EYECARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:MORALES
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:281-338-1230
Mailing Address - Street 1:610 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LEAGUE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77573-2458
Mailing Address - Country:US
Mailing Address - Phone:281-338-1230
Mailing Address - Fax:281-338-1239
Practice Address - Street 1:610 E MAIN ST
Practice Address - Street 2:
Practice Address - City:LEAGUE CITY
Practice Address - State:TX
Practice Address - Zip Code:77573-2458
Practice Address - Country:US
Practice Address - Phone:281-338-1230
Practice Address - Fax:281-338-1239
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5357TG152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX75022122OtherAETNA
TX10633OtherDAVIS
TX57733OtherSAFEGUARD
TX0078FEOtherBLUE CROSS BLUE SHIELD
TX926746OtherBLOCK VISION
TX926746OtherBLOCK VISION
TX=========0145OtherNVA
TX0078FEOtherBLUE CROSS BLUE SHIELD