Brazos Prof. Opt.

Primary specialty

OpticianTaxonomy code 156FX1800X

Legal business name

BRAZOS PROF. OPT.

Practice address

2901 E 29TH St Ste 105
Bryan, TX 77802-2691

Phone

(979) 776-7111

Fax

(979) 776-7112

NPI assigned

May 15, 2008

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Lester A Prove

Title

Owner

Phone

(979) 776-7111

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1210809600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1217289600000",
    "number": "1104093335",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2901 E 29TH ST STE 105",
            "city": "BRYAN",
            "state": "TX",
            "postal_code": "778022691",
            "telephone_number": "979-776-7111",
            "fax_number": "979-776-7112"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2901 E 29TH ST STE 105",
            "city": "BRYAN",
            "state": "TX",
            "postal_code": "778022691",
            "telephone_number": "979-776-7111",
            "fax_number": "979-776-7112"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRAZOS PROF. OPT.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-05-15",
        "last_updated": "2008-07-29",
        "status": "A",
        "authorized_official_last_name": "PROVE",
        "authorized_official_first_name": "LESTER",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "979-776-7111",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "156FX1800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Technician/Technologist, Optician",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "09779001",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Brazos Valley Colorectal Surgery, PLLC

• All providers in Bryan, TX
• Optician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 29, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.