Healthcare Provider Details

I. General information

NPI: 1497748388
Provider Name (Legal Business Name): VISION CENTER OF MAGNOLIA, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2005
Last Update Date: 04/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

306 MAGNOLIA BLVD
MAGNOLIA TX
77355-8535
US

IV. Provider business mailing address

306 MAGNOLIA BLVD
MAGNOLIA TX
77355-8535
US

V. Phone/Fax

Practice location:
  • Phone: 281-259-2020
  • Fax: 281-259-6866
Mailing address:
  • Phone: 281-259-2020
  • Fax: 281-259-6866

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number3871TG
License Number StateTX

VIII. Authorized Official

Name: DR. RHONDA MANUEL-SALDIVAR
Title or Position: PRESIDENT
Credential: O.D.
Phone: 281-259-2020