NPIMap

Organization Active NPI

Dejean & Kuglen Eye Associates LLP

Doing business as Avery Eye Clinic

  • Ophthalmology Physician
  • Conroe, TX
National Provider Identifier
1952322067
Registry record updated Jul 11, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
License
207W00000X Issued in TX
Legal business name
DEJEAN & KUGLEN EYE ASSOCIATES LLP
Doing business as
Avery Eye Clinic
Practice address
400 S Loop 336 W
Conroe, TX 77304-3302
Phone
(936) 539-4500
Fax
(936) 539-4050
NPI assigned
Jul 22, 2006
Last updated
Jul 11, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 11, 2022

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

Authorized official

Name
Mrs. Shirin Villegas
Title
Clinic Administrator
Phone
(936) 539-4500

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ophthalmology Physician 207W00000X 207W00000X TX Primary

Addresses

Primary practice location

400 S Loop 336 W
Conroe, TX 77304-3302

Mailing address

400 S Loop 336 W
Conroe, TX 77304-3302
Phone (936) 539-4500

Other practice location 1

129 Vision Park Blvd Ste 110
Shenandoah, TX 77384-3024
Phone (936) 539-4500

Other practice location 2

3361 Montgomery Rd
Huntsville, TX 77340-6416
Phone (936) 539-4500

Other names 1

  • Avery Eye Clinic Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040612000114 TX Part B Supplier - Clinic/Group Practice 8527041128 Receives reassigned benefits from 9 practitioners
Practice locations: Conroe, TX; Huntsville, TX; Shenandoah, TX

National Provider Directory

National Provider Directory

Locations

400 S Loop 336 W
Ste D
Conroe, TX 77304

Ownership & related parties

Subparts reporting this organization as parent 3

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 9

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1153526400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1657497600000",
    "number": "1952322067",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 S LOOP 336 W",
            "city": "CONROE",
            "state": "TX",
            "postal_code": "773043302",
            "telephone_number": "936-539-4500",
            "fax_number": "936-539-1216"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 S LOOP 336 W",
            "city": "CONROE",
            "state": "TX",
            "postal_code": "773043302",
            "telephone_number": "936-539-4500",
            "fax_number": "936-539-4050"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "129 Vision Park Blvd Ste 110",
            "address_purpose": "LOCATION",
            "city": "Shenandoah",
            "state": "TX",
            "postal_code": "773843024",
            "country_code": "US",
            "telephone_number": "936-539-4500",
            "fax_number": "936-539-4050",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3361 Montgomery Rd",
            "address_purpose": "LOCATION",
            "city": "Huntsville",
            "state": "TX",
            "postal_code": "773406416",
            "country_code": "US",
            "telephone_number": "936-539-4500",
            "fax_number": "936-539-4050",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "DEJEAN & KUGLEN EYE ASSOCIATES LLP",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-22",
        "last_updated": "2022-07-11",
        "certification_date": "2022-07-11",
        "status": "A",
        "authorized_official_last_name": "VILLEGAS",
        "authorized_official_first_name": "SHIRIN",
        "authorized_official_title_or_position": "CLINIC ADMINISTRATOR",
        "authorized_official_telephone_number": "936-539-4500",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "TX",
            "license": "207W00000X",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Avery Eye Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Avery Eye Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Conroe, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 11, 2022; 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.