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General NPI Number Information
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NPI Number | 1598056855
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Entity Type | Organization
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Legal Business Name | PEARLAND PROFESSIONAL VISION PLLC
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Dates
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Enumeration Date | 04/21/2011
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Last Update Date | 12/18/2013
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Provider Practice Location Address
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Address Line | 9215 BROADWAY ST SUITE 119
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City | PEARLAND
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State | TX
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Zip | 77584-8987
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Country | US
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Telephone | 281-997-2015
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Fax | 281-997-2016
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Provider Business Mailing Address
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Address Line | 9215 BROADWAY ST SUITE 119
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City | PEARLAND
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State | TX
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Zip | 77584-8987
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Country | US
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Telephone | 281-997-2015
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Fax | 281-997-2016
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Authorized Official
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Title or Position | OWNER-OPTOMETRIST
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Name | DR. AMIE SUSSAN GISBERT
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Credential |
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Telephone | 281-997-2015
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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 | 7400TG
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License Number State | TX
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