Healthcare Provider Details

I. General information

NPI: 1649594250
Provider Name (Legal Business Name): ID VISION CENTER PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/25/2010
Last Update Date: 12/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17454 NORTHWEST FWY
HOUSTON TX
77040-1002
US

IV. Provider business mailing address

17454 NORTHWEST FWY
HOUSTON TX
77040-1002
US

V. Phone/Fax

Practice location:
  • Phone: 281-372-6686
  • Fax: 888-876-6445
Mailing address:
  • Phone: 281-372-6686
  • Fax: 888-876-6445

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WV0400X
TaxonomyVision Therapy Optometrist
License Number05739TG
License Number StateTX

VIII. Authorized Official

Name: DR. HANH MK NGUYEN
Title or Position: DOCTOR OF OPTOMETRY/ OWNER
Credential: O.D
Phone: 281-372-6686