Basic Information
| Provider Information | |||||||||
| NPI: | 1831217603 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ABILENE EYE INSTITUTE LAB | ||||||||
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| OtherOrganizationName: | ABILENE EYE INSTITUTE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2120 ANTILLEY RD | ||||||||
| Address2: | |||||||||
| City: | ABILENE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 796065211 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3256952020 | ||||||||
| FaxNumber: | 3256952326 | ||||||||
| Practice Location | |||||||||
| Address1: | 2120 ANTILLEY RD | ||||||||
| Address2: | |||||||||
| City: | ABILENE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 796065211 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3256952020 | ||||||||
| FaxNumber: | 3256952326 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/27/2007 | ||||||||
| LastUpdateDate: | 03/20/2008 | ||||||||
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| AuthorizedOfficialLastName: | PRIESTNER | ||||||||
| AuthorizedOfficialFirstName: | VINCENT | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | LAB DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 3256952020 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | ABILENE EYE INSTITUTE | ||||||||
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| AuthorizedOfficialCredential: | M D | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 291U00000X | TX | Y | Laboratories | Clinical Medical Laboratory |
ID Information
| ID | Type | State | Issuer | Description | CP0048 | 01 | TX | RAILROAD MEDICARE GROUP | OTHER |