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General NPI Number Information
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NPI Number | 1992369854
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Entity Type | Organization
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Legal Business Name | BESPOKE VISION PLLC
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Dates
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Enumeration Date | 04/25/2019
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Last Update Date | 04/25/2019
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Provider Practice Location Address
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Address Line | 1916 W 18TH ST
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City | HOUSTON
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State | TX
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Zip | 77008-1206
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Country | US
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Telephone | 713-367-0024
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Fax |
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Provider Business Mailing Address
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Address Line | 2700 REVERE ST APT 144
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City | HOUSTON
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State | TX
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Zip | 77098-1347
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Country | US
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Telephone | 713-367-0024
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Fax |
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Authorized Official
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Title or Position | OD/OWNER
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Name | KIM MAI NGUYEN
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Credential |
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Telephone | 713-367-0024
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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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