MEDICARE: JESUS VISION LLC

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	8180TG	TX

General Provider Information

NPI Number	:	1144757675
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JESUS VISION LLC

Provider Business Mailing Address
First Line	:	11660 WESTHEIMER RD STE 125
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77077-6798
Country	:	US
Telephone Number	:	281-752-4100
Fax Number	:

Provider Business Practice Location Address
First Line	:	11660 WESTHEIMER RD STE 125
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77077-6798
Country	:	US
Telephone Number	:	281-752-4100
Fax Number	:

Authorized Official
Title or Position	:	OPTOMETRIST
Name	:	BEREKET HAILEAB TSEGAI
Credential	:	OD
Telephone Number	:	713-459-2754

Provider Enumeration Date	:	05/15/2017
Last Update Date	:	07/21/2022

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Directions to “JESUS VISION LLC ” Practice Location

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