MEDICARE: VISION TRENDS - KINGWOOD PA

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

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	:	1700828308
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VISION TRENDS - KINGWOOD PA

Provider Business Mailing Address
First Line	:	402 SAWDUST RD
Second Line	:
City	:	THE WOODLANDS
State	:	TX
Zip	:	77380-2243
Country	:	US
Telephone Number	:	281-363-2020
Fax Number	:

Provider Business Practice Location Address
First Line	:	4333 KINGWOOD DR
Second Line	:
City	:	HUMBLE
State	:	TX
Zip	:	77339-3700
Country	:	US
Telephone Number	:	281-360-1006
Fax Number	:	281-360-2233

Authorized Official
Title or Position	:	OWNER
Name	:	VISION TRENDS
Credential	:
Telephone Number	:	281-363-2020

Provider Enumeration Date	:	06/11/2006
Last Update Date	:	01/18/2022

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