MEDICARE: IDEAL VISION CARE PLLC

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

General Provider Information

NPI Number	:	1659044097
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IDEAL VISION CARE PLLC

Provider Business Mailing Address
First Line	:	5936 HIGHWAY 6 STE B
Second Line	:
City	:	MISSOURI CITY
State	:	TX
Zip	:	77459-4162
Country	:	US
Telephone Number	:	346-395-5588
Fax Number	:

Provider Business Practice Location Address
First Line	:	5936 HIGHWAY 6
Second Line	:
City	:	MISSOURI CITY
State	:	TX
Zip	:	77459-4162
Country	:	US
Telephone Number	:	832-348-6218
Fax Number	:

Authorized Official
Title or Position	:	OPTOMETRIST
Name	:	TERESA TO
Credential	:	OD
Telephone Number	:	346-395-5588

Provider Enumeration Date	:	07/30/2021
Last Update Date	:	10/12/2023

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