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General NPI Number Information
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NPI Number | 1457308306
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Entity Type | Organization
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Legal Business Name | VISION SOURCE - ATASCOCITA, P.A.
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Dates
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Enumeration Date | 05/27/2006
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Last Update Date | 03/18/2008
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Provider Practice Location Address
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Address Line | 5514 ATASCOCITA RD SUITE 100
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City | HUMBLE
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State | TX
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Zip | 77346-2837
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Country | US
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Telephone | 281-548-2020
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Fax |
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Provider Business Mailing Address
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Address Line | 11928 SIMMONS DR
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City | CLEVELAND
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State | TX
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Zip | 77328-7202
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Country | US
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Telephone | 281-728-9798
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JANET LEE BLOCK
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Credential | O.D.
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Telephone | 281-728-9798
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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 | 05030TG
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License Number State | TX
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