Organization
DEHAVEN EYE CLINIC PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. GINA LOWNDES (FINANCIAL SERVICE MANAGER)
(903) 595-7510
Entity
Organization
Contact information
Practice address
1424 E FRONT ST, TYLER, TX 75702-8501
(903) 595-4144
(903) 526-5491
Mailing address
PO BOX 130639, TYLER, TX 75713-0639
(903) 595-4144
(903) 526-5491
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00C25J
BLUE CROSS BLUE SHIELD
TX
05
—
120728405
—
TX
Enumeration date
01/22/2007
Last updated
09/18/2017
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