MEDICARE: GLIMPSE EYE CARE LLC

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	:	1922607902
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GLIMPSE EYE CARE LLC

Provider Business Mailing Address
First Line	:	3151 WATERS VIEW DR
Second Line	:
City	:	SUGAR LAND
State	:	TX
Zip	:	77478-4473
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	26435 KUYKENDAHL RD STE 800
Second Line	:
City	:	TOMBALL
State	:	TX
Zip	:	77375-1855
Country	:	US
Telephone Number	:	832-554-1100
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	WARREN CHEN
Credential	:	OD
Telephone Number	:	832-466-9291

Provider Enumeration Date	:	10/21/2020
Last Update Date	:	11/12/2020

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