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Organization
BRAZOSPORT EYE FACILITY, INC.
Active
Organization
BRAZOSPORT EYE FACILITY, INC.
Active
Other names
Brazosport Eye Institute
Organization subpart
No
Provider details
NPI number
Authorized official
DONNA GRADY (ADMINISTRATOR)
(979) 297-2961
Entity
Organization
Contact information
Practice address
103 PARKING WAY ST, LAKE JACKSON, TX 77566-5228
(979) 297-2961
(979) 297-2395
Mailing address
103 PARKING WAY ST, LAKE JACKSON, TX 77566-5228
(979) 297-2961
(979) 297-2395
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
157
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
085885401
—
TX
Enumeration date
02/22/2007
Last updated
08/10/2010
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