Provider Demographics
NPI:1548314818
Name:EYE CLINIC OF HOUSTON
Entity type:Organization
Organization Name:EYE CLINIC OF HOUSTON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:A
Authorized Official - Last Name:POWELL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:662-456-2020
Mailing Address - Street 1:812 N JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:MS
Mailing Address - Zip Code:38851-1203
Mailing Address - Country:US
Mailing Address - Phone:662-456-2020
Mailing Address - Fax:662-456-3494
Practice Address - Street 1:812 N JACKSON ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:MS
Practice Address - Zip Code:38851-1203
Practice Address - Country:US
Practice Address - Phone:662-456-2020
Practice Address - Fax:662-456-3494
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2009-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS580152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS09013893Medicaid
MSC01048Medicare PIN
MS09013893Medicaid