Provider Demographics
NPI:1316339062
Name:BEYOND EYE CARE PLLC
Entity type:Organization
Organization Name:BEYOND EYE CARE PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KERRIANN
Authorized Official - Middle Name:COOMBS
Authorized Official - Last Name:HODGE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:281-630-7994
Mailing Address - Street 1:6931 FM 1960 RD E
Mailing Address - Street 2:NEXT TO TARGET OPTICAL
Mailing Address - City:ATASCOCITA
Mailing Address - State:TX
Mailing Address - Zip Code:77346-2705
Mailing Address - Country:US
Mailing Address - Phone:281-630-7994
Mailing Address - Fax:
Practice Address - Street 1:25510 BUFFALO SPRINGS CT
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77373
Practice Address - Country:US
Practice Address - Phone:281-630-7994
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-04
Last Update Date:2015-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7449TG305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX212047901Medicaid
TX1811213739Medicare PIN