Provider Demographics
NPI:1104148253
Name:EYEMASTERS OF TEXAS, LTD
Entity type:Organization
Organization Name:EYEMASTERS OF TEXAS, LTD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF MANAGED VISION CARE
Authorized Official - Prefix:
Authorized Official - First Name:DOROTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:REYNOLDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-524-6515
Mailing Address - Street 1:PO BOX 848449
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-8449
Mailing Address - Country:US
Mailing Address - Phone:210-340-3531
Mailing Address - Fax:
Practice Address - Street 1:5866 E SAM HOUSTON PKWY N
Practice Address - Street 2:STE. A
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77049-2527
Practice Address - Country:US
Practice Address - Phone:281-454-6071
Practice Address - Fax:281-459-2735
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-17
Last Update Date:2010-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX4806290102Medicare NSC