Healthcare Provider Details

I. General information

NPI: 1902727340
Provider Name (Legal Business Name): HEATH VISION SOURCE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2026
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4260 RIDGE RD SUITE 101
HEATH TX
75032
US

IV. Provider business mailing address

4260 RIDGE RD SUITE 101
HEATH TX
75032
US

V. Phone/Fax

Practice location:
  • Phone: 972-942-9197
  • Fax: 972-942-9194
Mailing address:
  • Phone: 972-942-9197
  • Fax: 972-942-9194

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: JERRY CHIH
Title or Position: OWNER
Credential: OD
Phone: 832-798-3813