1407143076 NPI number — WESTSIDE EYE CARE

Table of content: (NPI 1407143076)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407143076 NPI number — WESTSIDE EYE CARE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WESTSIDE EYE CARE
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:
1407143076
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/06/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 8176
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOUSTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77288-8176
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
281-235-5443
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1560 ELDRIDGE PKWY
Provider Second Line Business Practice Location Address:
SUITE 136
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77077-1761
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
281-235-5443
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/05/2011

Additional Information

Authorized Official

Authorized Official Last Name:
NGUYEN
Authorized Official First Name:
THAO
Authorized Official Middle Name:
THIEN
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
281-235-5442

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 7728TG . This is a "TEXAS OPTOMETRY LICENSE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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