=====================================================
General NPI Number Information
=====================================================
NPI Number | 1407986771
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | OMNIVISION EYE CARE PROFESSIONAL CORPORATION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/06/2007
-----------------------------------------------------
Last Update Date | 05/11/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4112 N JOSEY LN STE 112
-----------------------------------------------------
City | CARROLLTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75007-1509
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-939-5367
-----------------------------------------------------
Fax | 972-939-5365
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4112 N JOSEY LN STE 112
-----------------------------------------------------
City | CARROLLTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75007-1509
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-939-5367
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. THOAI PETER BUI
-----------------------------------------------------
Credential | O.D.
-----------------------------------------------------
Telephone | 972-939-5367
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 6571TG
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------