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General NPI Number Information
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NPI Number | 1174706220
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Entity Type | Organization
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Legal Business Name | SPACE CITY VISION CENTER
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Dates
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Enumeration Date | 12/12/2007
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Last Update Date | 12/12/2007
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Provider Practice Location Address
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Address Line | 17100 GLENMOUNT PARK DR SUITE B
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City | WEBSTER
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State | TX
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Zip | 77598-4368
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Country | US
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Telephone | 281-488-8860
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Fax | 281-488-0775
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Provider Business Mailing Address
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Address Line | 17100 GLENMOUNT PARK DR SUITE B
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City | WEBSTER
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State | TX
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Zip | 77598-4368
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Country | US
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Telephone | 281-488-8860
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Fax | 281-488-0775
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Authorized Official
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Title or Position | DOCTOR/OWNER
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Name | DR. GEORGE LOUIS HALL JR.
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Credential | O.D.
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Telephone | 281-488-8860
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152WC0802X
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Taxonomy Name | Corneal and Contact Management Optometrist
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License Number | 2091TG
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License Number State | TX
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