Provider Demographics
NPI:1023506516
Name:PINEY WOODS FAMILY EYECARE
Entity type:Organization
Organization Name:PINEY WOODS FAMILY EYECARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTER
Authorized Official - Prefix:DR
Authorized Official - First Name:JARED
Authorized Official - Middle Name:RYAN
Authorized Official - Last Name:LAMBSON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:480-375-8908
Mailing Address - Street 1:701 W SOUTHWEST LOOP 323
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75701-9410
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:701 W SOUTHWEST LOOP 323
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-9410
Practice Address - Country:US
Practice Address - Phone:480-375-8908
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-30
Last Update Date:2018-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty