NPIMap

Organization Active NPI

East Texas Eye Care Associates, PLLC

Doing business as The Optical Shop

  • Optician
  • Athens, TX
National Provider Identifier
1386660942
Registry record updated Feb 16, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
OpticianTaxonomy code 156FX1800X
Legal business name
EAST TEXAS EYE CARE ASSOCIATES, PLLC
Doing business as
The Optical Shop
Practice address
608 Maryland Dr
Athens, TX 75751-3332
Phone
(903) 675-6440
Fax
(903) 675-6676
NPI assigned
Jul 15, 2006
Last updated
Feb 16, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 16, 2015

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

Authorized official

Name
Mrs. June Cheatham
Title
Administrator
Phone
(903) 595-0500

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optician 156FX1800X NU Primary

Addresses

Primary practice location

608 Maryland Dr
Athens, TX 75751-3332

Mailing address

2440 E 5TH St
Tyler, TX 75701-3525
Phone (903) 595-0500

Other identifiers 1

IdentifierTypeStateIssuer
085828404MedicaidTX

Other names 1

  • The Optical Shop Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100930059255 TX DME Supplier - Physician - OphthalmologyDME Supplier - Physician - Optometrist 2567454085 Practice locations: Athens, TX

Other NPIs with the same Medicare PAC ID 3

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Eye Care Associates of4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

Locations

608 Maryland Dr
Athens, TX 75751
Phone (903) 675-6440

NPI Registry JSON

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

{
    "created_epoch": "1152921600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1424044800000",
    "number": "1386660942",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2440 E 5TH ST",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757013525",
            "telephone_number": "903-595-0500",
            "fax_number": "903-595-1212"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "608 MARYLAND DR",
            "city": "ATHENS",
            "state": "TX",
            "postal_code": "757513332",
            "telephone_number": "903-675-6440",
            "fax_number": "903-675-6676"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EAST TEXAS EYE CARE ASSOCIATES, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-15",
        "last_updated": "2015-02-16",
        "status": "A",
        "authorized_official_last_name": "CHEATHAM",
        "authorized_official_first_name": "JUNE",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "903-595-0500",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "156FX1800X",
            "taxonomy_group": "",
            "desc": "Technician/Technologist, Optician",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "085828404",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "The Optical Shop",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Athens, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 16, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.