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General NPI Number Information
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NPI Number | 1144757675
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Entity Type | Organization
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Legal Business Name | JESUS VISION LLC
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Dates
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Enumeration Date | 05/15/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 11660 WESTHEIMER RD STE 125
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City | HOUSTON
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State | TX
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Zip | 77077-6798
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Country | US
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Telephone | 281-752-4100
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Fax |
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Provider Business Mailing Address
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Address Line | 11660 WESTHEIMER RD STE 125
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City | HOUSTON
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State | TX
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Zip | 77077-6798
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Country | US
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Telephone | 281-752-4100
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Fax |
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | BEREKET HAILEAB TSEGAI
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Credential | OD
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Telephone | 713-459-2754
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 8180TG
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License Number State | TX
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