1245413384 NPI number — MJC VISION

Table of content: (NPI 1245413384)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245413384 NPI number — MJC VISION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MJC VISION
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:
1245413384
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/10/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7728 MID CITIES BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORTH RICHLAND HILLS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76180-4621
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
817-281-3386
Provider Business Mailing Address Fax Number:
817-281-9287

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7728 MID CITIES BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORTH RICHLAND HILLS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76180-4621
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
817-281-3386
Provider Business Practice Location Address Fax Number:
817-281-9287
Provider Enumeration Date:
12/12/2007

Additional Information

Authorized Official

Authorized Official Last Name:
CONTALDI
Authorized Official First Name:
MARIO
Authorized Official Middle Name:
JOSEPH
Authorized Official Title or Position:
OPTOMETRIST
Authorized Official Telephone Number:
817-281-3386

Provider Taxonomy Codes

  • Taxonomy code: 152WC0802X , with the licence number:  03329TG , 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: 191450902 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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