Provider Demographics
NPI:1568633873
Name:EYECARE 2000 PA
Entity type:Organization
Organization Name:EYECARE 2000 PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:THAI
Authorized Official - Middle Name:DINH-MINH
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:713-771-9998
Mailing Address - Street 1:5700 S GESSNER DR
Mailing Address - Street 2:SUITE L
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77036-1699
Mailing Address - Country:US
Mailing Address - Phone:713-771-9998
Mailing Address - Fax:713-771-9997
Practice Address - Street 1:5700 S GESSNER DR
Practice Address - Street 2:SUITE L
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77036-1699
Practice Address - Country:US
Practice Address - Phone:713-771-9998
Practice Address - Fax:713-771-9997
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-13
Last Update Date:2019-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4524T305R00000X
305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX019292401Medicaid
TXNG000E29POtherMEDICARE ID
TX019292401Medicaid