Healthcare Provider Details

I. General information

NPI: 1730227869
Provider Name (Legal Business Name): VISION MAX-BAYTOWN PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2007
Last Update Date: 04/13/2023
Certification Date: 04/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1819 COMMON ST
HOUSTON TX
77009-8628
US

IV. Provider business mailing address

1819 COMMON ST
HOUSTON TX
77009-8628
US

V. Phone/Fax

Practice location:
  • Phone: 713-598-7268
  • Fax: 409-932-2597
Mailing address:
  • Phone: 713-598-7268
  • Fax: 409-932-2597

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License Number2630T
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code152WS0006X
TaxonomySports Vision Optometrist
License Number2630T
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code152WX0102X
TaxonomyOccupational Vision Optometrist
License Number2630T
License Number StateTX
# 4
Primary TaxonomyY
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number2630T
License Number StateTX

VIII. Authorized Official

Name: DR. TIMOTHY PLANTY
Title or Position: PRESIDENT OWNER
Credential: O.D.
Phone: 281-421-2020