Provider Demographics
NPI:1548331887
Name:THE VISION CENTER EYE ASSOCIATES, PLLC
Entity type:Organization
Organization Name:THE VISION CENTER EYE ASSOCIATES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:KAMI
Authorized Official - Middle Name:
Authorized Official - Last Name:CAVAZOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:806-778-0214
Mailing Address - Street 1:3104 INDIANA AVE
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79410-3148
Mailing Address - Country:US
Mailing Address - Phone:806-793-1927
Mailing Address - Fax:806-791-4077
Practice Address - Street 1:3104 INDIANA AVE
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79410-3148
Practice Address - Country:US
Practice Address - Phone:806-793-1927
Practice Address - Fax:806-791-4077
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-10
Last Update Date:2021-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3680TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
5057550001Medicare NSC
TX00672UMedicare PIN