Healthcare Provider Details

I. General information

NPI: 1093083636
Provider Name (Legal Business Name): US VISION GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/10/2011
Last Update Date: 12/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1515 N TOWN EAST BLVD SUITE 523B
MESQUITE TX
75150-4157
US

IV. Provider business mailing address

1515 N TOWN EAST BLVD SUITE 523B
MESQUITE TX
75150-4157
US

V. Phone/Fax

Practice location:
  • Phone: 972-638-8600
  • Fax:
Mailing address:
  • Phone: 972-638-8600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number7845T
License Number StateTX

VIII. Authorized Official

Name: DR. TASNEEM MAMDANI
Title or Position: PRESIDENT
Credential: O.D.
Phone: 505-232-2020