Organization
GULF COAST EYE CENTER, P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JANE HOYT LEIDLEIN M.D. (PRESIDENT)
(979) 297-4042
Entity
Organization
Contact information
Practice address
117 CIRCLE WAY ST, LAKE JACKSON, TX 77566-5233
(979) 297-4042
(979) 297-4686
Mailing address
117 CIRCLE WAY ST, LAKE JACKSON, TX 77566-5233
(979) 297-4042
(979) 297-4686
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
—
—
261QS0132X
Ophthalmologic Surgery Clinic/Center
Primary
J4298
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
096931303
—
TX
01
—
180036211
RAILROAD MEDICARE
TX
01
—
28MV
BCBS
TX
Enumeration date
05/08/2007
Last updated
07/13/2020
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