Healthcare Provider Details

I. General information

NPI: 1215391404
Provider Name (Legal Business Name): ZOOM EYECARE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/13/2016
Last Update Date: 10/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7800 N NAVARRO ST STE 223
VICTORIA TX
77904-2699
US

IV. Provider business mailing address

7800 N NAVARRO ST STE 223
VICTORIA TX
77904-2699
US

V. Phone/Fax

Practice location:
  • Phone: 361-572-0411
  • Fax:
Mailing address:
  • Phone: 361-572-0411
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number7929TG
License Number StateTX

VIII. Authorized Official

Name: DR. SIDRA KHALID
Title or Position: PROVIDER/MANAGING MEMBER
Credential: OD
Phone: 832-998-5310