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General NPI Number Information
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NPI Number | 1720526122
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Entity Type | Organization
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Legal Business Name | PRISTINE VISION PLLC
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Dates
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Enumeration Date | 02/06/2017
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Last Update Date | 02/06/2017
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Provider Practice Location Address
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Address Line | 2700 ELDRIDGE PKWY
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City | HOUSTON
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State | TX
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Zip | 77082-6870
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Country | US
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Telephone | 832-791-3393
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Fax | 832-681-8362
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Provider Business Mailing Address
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Address Line | 3333 WESLAYAN ST UNIT 1223
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City | HOUSTON
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State | TX
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Zip | 77027-6359
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Country | US
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Telephone | 832-791-3393
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Fax | 832-681-8362
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | AMY LO
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Credential | O.D.
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Telephone | 832-791-3393
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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 | 7749
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License Number State | TX
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