MEDICARE: OPTICAL EDGE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	7262TG	TX

General Provider Information

NPI Number	:	1043606197
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OPTICAL EDGE

Provider Business Mailing Address
First Line	:	14870 SPACE CENTER BLVD
Second Line	:	SUITE H
City	:	HOUSTON
State	:	TX
Zip	:	77062-2368
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	14870 SPACE CENTER BLVD
Second Line	:	SUITE H
City	:	HOUSTON
State	:	TX
Zip	:	77062-2368
Country	:	US
Telephone Number	:	281-984-7515
Fax Number	:	855-751-5551

Authorized Official
Title or Position	:	OWNER
Name	:	REGINA THUY VY NGUYEN
Credential	:	OD
Telephone Number	:	281-984-7515

Provider Enumeration Date	:	04/15/2015
Last Update Date	:	12/07/2017

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Directions to “OPTICAL EDGE ” Practice Location

Language	Start Address	Practice Location

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