Organization
BRAZOSPORT EYE FACILITY, INC.
Active
Other names
Brazosport Eye Institute
Organization subpart
No
Provider details
NPI number
Authorized official
DONNA GRADY (ADMINISTRATOR)
(979) 297-2961
Entity
Organization
Contact information
Practice address
103 PARKING WAY ST, LAKE JACKSON, TX 77566-5228
(979) 297-2961
(979) 297-2395
Mailing address
103 PARKING WAY ST, LAKE JACKSON, TX 77566-5228
(979) 297-2961
(979) 297-2395
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
157
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
085885401
—
TX
Enumeration date
02/22/2007
Last updated
08/10/2010
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