MEDICARE: SOUTHERN VISION CENTER, P.A.

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	152WC0802X	Corneal and Contact Management Optometrist	4715TG	TX

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	:	1750301255
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTHERN VISION CENTER, P.A.

Provider Business Mailing Address
First Line	:	8506 HIGHWAY 6 N
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77095-2103
Country	:	US
Telephone Number	:	281-550-3600
Fax Number	:	280-550-3898

Provider Business Practice Location Address
First Line	:	8506 HIGHWAY 6 N
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77095-2103
Country	:	US
Telephone Number	:	281-550-3600
Fax Number	:	280-550-3898

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. PERRY JOHN SOLI
Credential	:	O.D.
Telephone Number	:	281-550-3600

Provider Enumeration Date	:	07/20/2006
Last Update Date	:	08/31/2009

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