1891978896 NPI number — GULFGATE VISION PC

Table of content: (NPI 1891978896)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891978896 NPI number — GULFGATE VISION PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GULFGATE VISION 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:
Provider Other Organization Name Type Code:
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:
1891978896
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/06/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6888 GULF FWY STE 614
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:
77087-2550
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
713-641-5353
Provider Business Mailing Address Fax Number:
713-645-1097

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6888 GULF FWY STE 614
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77087-2550
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
713-641-5353
Provider Business Practice Location Address Fax Number:
713-645-1097
Provider Enumeration Date:
12/12/2007

Additional Information

Authorized Official

Authorized Official Last Name:
ECHETEBU
Authorized Official First Name:
ZEINEP
Authorized Official Middle Name:
O.
Authorized Official Title or Position:
OWNER/OPTOMETRIST
Authorized Official Telephone Number:
713-641-5353

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  5392TG , 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: 47522 . This is a "SPECTERA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 83089E . This is a "B.C.B.S" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 7136415353 . This is a "VSP" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 918393 . This is a "BLOCK VISION" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 918393 . This is a "BLOCK VISION" identifier . This identifiers is of the category "OTHER".
  • Identifier: TX5392 . This is a "EYEMED" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 1430233-01 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 35616 . This is a "AVESIS" identifier . This identifiers is of the category "OTHER".




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