Healthcare Provider Details

I. General information

NPI: 1093890642
Provider Name (Legal Business Name): HOUSTON IN A VISION, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 08/21/2020
Certification Date: 08/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

820 PARK TWO DR
SUGAR LAND TX
77478-2840
US

IV. Provider business mailing address

4800 OVERTON PLZ STE 440
FORT WORTH TX
76109-4435
US

V. Phone/Fax

Practice location:
  • Phone: 713-271-7777
  • Fax: 713-271-8585
Mailing address:
  • Phone: 800-299-5161
  • Fax: 817-447-3033

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code315P00000X
TaxonomyIntellectual Disabilities Intermediate Care Facility
License Number118566
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code315P00000X
TaxonomyIntellectual Disabilities Intermediate Care Facility
License Number118578
License Number StateTX

VIII. Authorized Official

Name: MARK LASHLEY
Title or Position: CEO
Credential:
Phone: 800-299-5161