Provider Demographics
NPI:1003169269
Name:VICTORY LAKES EYE ASSOCIATES
Entity Type:Organization
Organization Name:VICTORY LAKES EYE ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TINA
Authorized Official - Middle Name:
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:713-819-4149
Mailing Address - Street 1:2910 GULF FWY S
Mailing Address - Street 2:SUITE F-2
Mailing Address - City:LEAGUE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77573-6790
Mailing Address - Country:US
Mailing Address - Phone:281-337-1081
Mailing Address - Fax:
Practice Address - Street 1:2910 GULF FWY S
Practice Address - Street 2:SUITE F-2
Practice Address - City:LEAGUE CITY
Practice Address - State:TX
Practice Address - Zip Code:77573-6790
Practice Address - Country:US
Practice Address - Phone:281-337-1081
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-24
Last Update Date:2012-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7414TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty