MEDICARE: PREMIER VISION CARE

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	6561TG	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	TXB104560	OTHER	TX	MEDICARE - GROUP PTAN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1255653614
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PREMIER VISION CARE

Provider Business Mailing Address
First Line	:	5866 E SAM HOUSTON PKWY N STE B
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77049-2527
Country	:	US
Telephone Number	:	281-436-1757
Fax Number	:	281-454-4825

Provider Business Practice Location Address
First Line	:	5866 E SAM HOUSTON PKWY N STE B
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77049-2527
Country	:	US
Telephone Number	:	281-436-1757
Fax Number	:	281-454-4825

Authorized Official
Title or Position	:	OWNER
Name	:	DR. CHAN QUACH
Credential	:	O.D.
Telephone Number	:	281-436-1757

Provider Enumeration Date	:	02/25/2010
Last Update Date	:	05/18/2011

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Directions to “PREMIER VISION CARE ” Practice Location

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