Texas State Optical of Bryan PC

Primary specialty

Eyewear SupplierTaxonomy code 332H00000X

Legal business name

TEXAS STATE OPTICAL OF BRYAN PC

Practice address

3030 E 29TH St
Suite 106
Bryan, TX 77802-2757

Phone

(979) 731-8446

NPI assigned

Dec 4, 2007

Organization subpart

No

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

Authorized official

Name

Gerald D Phillips

Title

Doctor

Phone

(979) 731-8446

Specialties & licenses 1

Addresses

Other identifiers 8

Locations

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

{
    "created_epoch": "1196726400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1222992000000",
    "number": "1275715963",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3030 E 29TH ST",
            "address_2": "SUITE 106",
            "city": "BRYAN",
            "state": "TX",
            "postal_code": "778022757"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3030 E 29TH ST",
            "address_2": "SUITE 106",
            "city": "BRYAN",
            "state": "TX",
            "postal_code": "778022757",
            "telephone_number": "979-731-8446"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TEXAS STATE OPTICAL OF BRYAN PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-12-04",
        "last_updated": "2008-10-03",
        "status": "A",
        "authorized_official_last_name": "PHILLIPS",
        "authorized_official_first_name": "GERALD",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "DOCTOR",
        "authorized_official_telephone_number": "979-731-8446"
    },
    "taxonomies": [
        {
            "code": "332H00000X",
            "taxonomy_group": "",
            "desc": "Eyewear Supplier",
            "state": "TX",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SPECTERA",
            "identifier": "16110",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AVESIS",
            "identifier": "6271",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "80323E",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLOCK VISION",
            "identifier": "902303",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "112311903",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SCOTT & WHITE",
            "identifier": "16258",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "EYEMED",
            "identifier": "TX2145",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SAFEGUARD",
            "identifier": "59496",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Eyewear Supplier in Bryan, TX
• Providers in Bryan, TX by specialty
• Eyewear Supplier in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 3, 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.