Organization
LYLE THORSTENSON, MD
Active
Other names
Thorstenson Eye Clinic, Optical, ASC
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LYLE S THORSTENSON M.D. (OWNER/PHYSICIAN)
(936) 564-2411
Entity
Organization
Contact information
Practice address
3302 NE STALLINGS DR, NACOGDOCHES, TX 75965-8727
(936) 564-2411
(936) 564-1280
Mailing address
PO BOX 632020, NACOGDOCHES, TX 75963-2020
(936) 564-2411
(936) 564-1280
Taxonomy
Speciality
Code
Description
License number
State
261QS0132X
Ophthalmologic Surgery Clinic/Center
Primary
F2064
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
451159
MEDICARE
TX
05
—
P000HH693
—
TX
Enumeration date
05/17/2006
Last updated
10/04/2007
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