Provider Demographics
NPI:1023375094
Name:NAVASOTA EYE CARE CENTER PLLC
Entity type:Organization
Organization Name:NAVASOTA EYE CARE CENTER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BELINDA
Authorized Official - Middle Name:SHAE
Authorized Official - Last Name:DOBSON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:979-779-9000
Mailing Address - Street 1:2320 E VILLA MARIA RD
Mailing Address - Street 2:
Mailing Address - City:BRYAN
Mailing Address - State:TX
Mailing Address - Zip Code:77802-2549
Mailing Address - Country:US
Mailing Address - Phone:979-779-9000
Mailing Address - Fax:
Practice Address - Street 1:501 E WASHINGTON AVE STE 5
Practice Address - Street 2:
Practice Address - City:NAVASOTA
Practice Address - State:TX
Practice Address - Zip Code:77868-3001
Practice Address - Country:US
Practice Address - Phone:979-779-9000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EYE CARE CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-04-16
Last Update Date:2012-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7126TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX613237OtherMEDICARE PTAN