1093943292 NPI number — ALLSEP VISION CENTER PC

Table of content: (NPI 1093943292)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093943292 NPI number — ALLSEP VISION CENTER PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ALLSEP VISION CENTER PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
VISION SOURCE PASADENA
Provider Other Organization Name Type Code:
5
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1093943292
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/17/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5233 FAIRMONT PKWY
Provider Second Line Business Mailing Address:
SUITE G1
Provider Business Mailing Address City Name:
PASADENA
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77505-3947
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
281-487-8100
Provider Business Mailing Address Fax Number:
281-487-8103

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5233 FAIRMONT PKWY
Provider Second Line Business Practice Location Address:
SUITE G1
Provider Business Practice Location Address City Name:
PASADENA
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77505-3947
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
281-487-8100
Provider Business Practice Location Address Fax Number:
281-487-8103
Provider Enumeration Date:
06/25/2009

Additional Information

Authorized Official

Authorized Official Last Name:
ALLSEP
Authorized Official First Name:
TAMMI
Authorized Official Middle Name:
CUTERET
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
281-487-8100

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  4765TG , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0096FF . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 0A3988 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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