Provider Demographics
NPI:1427134493
Name:EUBANK, LON WHITFIELD (OD)
Entity type:Individual
Prefix:
First Name:LON
Middle Name:WHITFIELD
Last Name:EUBANK
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2067
Mailing Address - Street 2:
Mailing Address - City:WHITNEY
Mailing Address - State:TX
Mailing Address - Zip Code:76692-5067
Mailing Address - Country:US
Mailing Address - Phone:254-694-3435
Mailing Address - Fax:254-694-9968
Practice Address - Street 1:1221B N BRAZOS
Practice Address - Street 2:
Practice Address - City:WHITNEY
Practice Address - State:TX
Practice Address - Zip Code:76692-2067
Practice Address - Country:US
Practice Address - Phone:254-694-3435
Practice Address - Fax:254-694-9968
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-31
Last Update Date:2013-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5119TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1508063504OtherFACILITY NPI
TX019553901Medicaid
TXU56986Medicare UPIN
TX00E89TMedicare ID - Type Unspecified
TX6009120001Medicare NSC