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General NPI Number Information
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NPI Number | 1497311427
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Entity Type | Organization
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Legal Business Name | 20/20 SUPREME EYECARE
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Dates
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Enumeration Date | 05/15/2019
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Last Update Date | 02/16/2024
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Provider Practice Location Address
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Address Line | 13003 TOMBALL PKWY
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City | HOUSTON
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State | TX
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Zip | 77086-3122
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Country | US
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Telephone | 281-405-8114
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Fax | 281-405-8104
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Provider Business Mailing Address
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Address Line | 6634 CALICO WOODS LN
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City | HOUSTON
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State | TX
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Zip | 77041-7281
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Country | US
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Telephone | 281-405-8114
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Fax | 281-405-8104
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | DR. MARY T NGUYEN
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Credential | OD
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Telephone | 281-405-8114
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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 |
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License Number State |
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