Basic Information
| Provider Information | |||||||||
| NPI: | 1528056975 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | GINTER EYECARE CENTER INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6010 82ND ST STE 100 | ||||||||
| Address2: | |||||||||
| City: | LUBBOCK | ||||||||
| State: | TX | ||||||||
| PostalCode: | 794240822 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8067988820 | ||||||||
| FaxNumber: | 8067989754 | ||||||||
| Practice Location | |||||||||
| Address1: | 6010 82ND ST STE 100 | ||||||||
| Address2: | |||||||||
| City: | LUBBOCK | ||||||||
| State: | TX | ||||||||
| PostalCode: | 794240822 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8067988820 | ||||||||
| FaxNumber: | 8067989754 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/10/2005 | ||||||||
| LastUpdateDate: | 12/13/2018 | ||||||||
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| AuthorizedOfficialLastName: | GINTER | ||||||||
| AuthorizedOfficialFirstName: | JEWELL | ||||||||
| AuthorizedOfficialMiddleName: | ELAINE | ||||||||
| AuthorizedOfficialTitleorPosition: | OPTOMETRIST PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8067988820 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | O.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152WC0802X | 3035TG | TX | N | 193200000X MULTI-SPECIALTY GROUP | Eye and Vision Services Providers | Optometrist | Corneal and Contact Management | 152WP0200X | 3035TG | TX | N | 193200000X MULTI-SPECIALTY GROUP | Eye and Vision Services Providers | Optometrist | Pediatrics | 152W00000X | 3035TG | TX | Y | 193200000X MULTI-SPECIALTY GROUP | Eye and Vision Services Providers | Optometrist |
ID Information
| ID | Type | State | Issuer | Description | 148340601 | 05 | TX | MEDICAID |