Organization
CLEAR LAKE EYE CENTER LLP
Active
Other names
Berkeley Eye Center Clear Lake
Organization subpart
No
Provider details
NPI number
Authorized official
MARK F MICHELETTI (EXECUTIVE DIRECTOR)
(713) 526-1600
Entity
Organization
Contact information
Practice address
1046 HERCULES, STE A, HOUSTON, TX 77058
(281) 488-0070
(281) 488-0078
Mailing address
3100 WESLAYAN, SUITE 400, HOUSTON, TX 77027
(713) 526-1600
(713) 526-6520
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
—
—
332H00000X
Eyewear Supplier
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0059FA
BLUE CROSS BLUE SHIELD
TX
01
—
4393740001
PALMETTO GBA
TX
Enumeration date
06/30/2005
Last updated
11/28/2007
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