Provider Demographics
NPI:1003857814
Name:VISION TRENDS - LOUETTA PA
Entity Type:Organization
Organization Name:VISION TRENDS - LOUETTA PA
Other - Org Name:EYE TRENDS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VISION
Authorized Official - Middle Name:
Authorized Official - Last Name:TRENDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-363-2020
Mailing Address - Street 1:402 SAWDUST RD
Mailing Address - Street 2:
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77380-2243
Mailing Address - Country:US
Mailing Address - Phone:281-363-2020
Mailing Address - Fax:
Practice Address - Street 1:4710 LOUETTA RD
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77388-4419
Practice Address - Country:US
Practice Address - Phone:281-350-2020
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-10
Last Update Date:2022-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1310810001Medicare ID - Type Unspecified