1598996779 NPI number — INVISION EYECARE, LLC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598996779 NPI number — INVISION EYECARE, LLC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INVISION EYECARE, LLC.
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:
Provider Other Organization Name Type Code:
6
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:
1598996779
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/10/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2924 S 31ST ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TEMPLE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76502-1861
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
254-770-2351
Provider Business Mailing Address Fax Number:
254-770-2299

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1121 BRIARCREST DR
Provider Second Line Business Practice Location Address:
STE. 302
Provider Business Practice Location Address City Name:
BRYAN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77802-2505
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
979-731-1920
Provider Business Practice Location Address Fax Number:
979-731-1920
Provider Enumeration Date:
08/05/2009

Additional Information

Authorized Official

Authorized Official Last Name:
KLEIN
Authorized Official First Name:
ANDREW
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
260-402-4775

Provider Taxonomy Codes

  • Taxonomy code: 332H00000X , 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: 579278 . This is a "BLUE CROSS BLUE SHIELD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 112655 . This is a "EYE MED" identifier . This identifiers is of the category "OTHER".




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