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General NPI Number Information
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NPI Number | 1750617544
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Entity Type | Organization
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Legal Business Name | MID COUNTY VISION INSIGHTS, PLLC
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Dates
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Enumeration Date | 10/28/2009
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Last Update Date | 09/10/2010
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Provider Practice Location Address
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Address Line | 3624 HIGHWAY 365
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City | NEDERLAND
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State | TX
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Zip | 77627-7835
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Country | US
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Telephone | 409-724-7700
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Fax | 409-724-7703
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Provider Business Mailing Address
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Address Line | 3624 HIGHWAY 365
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City | NEDERLAND
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State | TX
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Zip | 77627-7835
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Country | US
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Telephone | 409-724-7700
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Fax | 409-724-7703
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Authorized Official
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Title or Position | DOCTOR OF OPTOMETRY
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Name | DR. THAO LY PHUNG
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Credential | O.D.
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Telephone | 409-724-7700
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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 | 7245TG
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License Number State | TX
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