| Gulf Coast Eye Center, P.a. | |
|
117 Circle Way St Lake Jackson TX 77566-5233 | |
| (979) 297-4042 | |
| (979) 297-4686 |
| Full Name | Gulf Coast Eye Center, P.a. |
|---|---|
| Speciality | Clinic/Center |
| Location | 117 Circle Way St, Lake Jackson, Texas |
| Authorized Official Name and Position | Jane Hoyt Leidlein (PRESIDENT) |
| Authorized Official Contact | 9792974042 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Gulf Coast Eye Center, P.a. 117 Circle Way St Lake Jackson TX 77566-5233 Ph: (979) 297-4042 | Gulf Coast Eye Center, P.a. 117 Circle Way St Lake Jackson TX 77566-5233 Ph: (979) 297-4042 |
| NPI Number | 1366655854 |
|---|---|
| Provider Enumeration Date | 05/08/2007 |
| Last Update Date | 07/13/2020 |
| Medicare PECOS PAC ID | 0446313886 |
|---|---|
| Medicare Enrollment ID | O20090112000746 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1366655854 | NPI | - | NPPES |
| 180036211 | Other | TX | RAILROAD MEDICARE |
| 096931303 | Medicaid | TX | |
| 28MV | Other | TX | BCBS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Secondary |
| 261QS0132X | Clinic/center - Ophthalmologic Surgery | J4298 (Texas) | Primary |
| Provider Name | Jane H Leidlein |
|---|---|
| Provider Type | Practitioner - Ophthalmology |
| Provider Identifiers | NPI Number: 1235110719 PECOS PAC ID: 8729141262 Enrollment ID: I20090109000667 |
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