Organization
EAST TEXAS EYE CENTER PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KIM RAY SHRUM M.D. (PRESIDENT)
(281) 812-4000
Entity
Organization
Contact information
Practice address
18700 W LAKE HOUSTON PKWY, SUITE B101, HUMBLE, TX 77346-3349
(281) 812-4000
(281) 812-3331
Mailing address
18700 W LAKE HOUSTON PKWY, SUITE B101, HUMBLE, TX 77346-3349
(281) 812-4000
(281) 812-3331
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
—
—
207W00000X
Ophthalmology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0084GS
BLUECROSS BLUESHIELD GRP
TX
05
—
145198104
—
TX
01
—
20459
UTMB CHIPS
TX
01
—
24940
OPTICARE
TX
01
—
452026
NVA
TX
01
—
5248990
CCN / FIRST HEALTH
TX
01
—
55951
SAFEGUARD
TX
01
—
606334
CORE SOURCE/HEALTH LINK
TX
01
—
7114117
AETNA
TX
01
—
975250
ONE HEALTH PLAN
TX
01
—
DE8958
MEDICARE RAILROAD
TX
Enumeration date
09/21/2006
Last updated
06/04/2014
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