Provider Demographics
NPI:1932563228
Name:ALSUP EYECARE PLLC
Entity type:Organization
Organization Name:ALSUP EYECARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:K
Authorized Official - Last Name:ALSUP
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:361-929-5319
Mailing Address - Street 1:PO BOX 6362
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78466-6362
Mailing Address - Country:US
Mailing Address - Phone:361-929-5319
Mailing Address - Fax:844-272-9788
Practice Address - Street 1:6101 SARATOGA BLVD
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78414-2470
Practice Address - Country:US
Practice Address - Phone:361-929-5319
Practice Address - Fax:844-272-9788
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-12
Last Update Date:2022-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8201152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX4259723Medicaid