Organization
CENTRAL TEXAS EYE CLINIC, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LEWIS RICHARD KANNWISCHER M.D. (SECRETARY)
(254) 752-8328
Entity
Organization
Contact information
Practice address
601 W HIGHWAY 6, SUITE 108, WACO, TX 76710-5591
(254) 752-8328
(254) 752-7724
Mailing address
PO BOX 21385, WACO, TX 76702-1385
(254) 752-8328
(254) 752-7724
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00DT98
MEDICARE
TX
05
—
082246201
—
TX
Enumeration date
12/11/2006
Last updated
06/09/2009
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