Organization
ANGELO EYE ASSOCIATES PA
Active
Other names
Advanced Eye Care
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. LACI RAY (ASSISTANT)
(325) 944-8531
Entity
Organization
Contact information
Practice address
1721 KNICKERBOCKER RD, SAN ANGELO, TX 76904-5521
(325) 944-8531
(325) 944-4213
Mailing address
1721 KNICKERBOCKER RD, SAN ANGELO, TX 76904-5521
(325) 944-8531
(325) 944-4213
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
05712TG
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1114028883
INDIVIDUAL NPI
TX
05
—
1658809-01
—
TX
01
—
80301Q
BCBS
TX
Enumeration date
01/09/2007
Last updated
10/11/2016
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