=====================================================
General NPI Number Information
=====================================================
NPI Number | 1114212628
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | VIZIO OPTICAL INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/13/2011
-----------------------------------------------------
Last Update Date | 09/26/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6002 ROGERDALE RD STE 150
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77072
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-772-2020
-----------------------------------------------------
Fax | 713-772-2015
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6002 ROGERDALE RD STE 150
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77072-1659
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-772-2020
-----------------------------------------------------
Fax | 713-772-2015
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. HUNG HUY LE
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 713-772-2020
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332H00000X
-----------------------------------------------------
Taxonomy Name | Eyewear Supplier
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------