Healthcare Provider Details

I. General information

NPI: 1669278917
Provider Name (Legal Business Name): AEG TEXAS PROFESSIONAL PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/19/2025
Last Update Date: 02/19/2025
Certification Date: 02/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15337 SOUTHWEST FWY
SUGAR LAND TX
77478-3832
US

IV. Provider business mailing address

111 E 4TH ST STE 440
ALTON IL
62002-6206
US

V. Phone/Fax

Practice location:
  • Phone: 281-242-2020
  • Fax:
Mailing address:
  • Phone: 314-741-8183
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MELISSA ALLISON
Title or Position: SR. DIRECTOR MVC
Credential:
Phone: 314-741-8183