MEDICARE: CITI VISION CARE, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	5353TG	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1730294331	OTHER	TX	INDIVIDUAL NPI
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1194149450
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CITI VISION CARE, INC.

Provider Business Mailing Address
First Line	:	PO BOX 2159
Second Line	:
City	:	SUGAR LAND
State	:	TX
Zip	:	77487-2159
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	19511 INTERSTATE 45
Second Line	:
City	:	SPRING
State	:	TX
Zip	:	77388-6015
Country	:	US
Telephone Number	:	281-288-4447
Fax Number	:

Authorized Official
Title or Position	:	OWNER/OPTOMETRIST
Name	:	DR. KATE OPARA
Credential	:
Telephone Number	:	281-288-4447

Provider Enumeration Date	:	02/06/2014
Last Update Date	:	02/06/2014

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