Provider Demographics
NPI:1033481536
Name:REVOLUTION EYES PLLC
Entity Type:Organization
Organization Name:REVOLUTION EYES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:VI
Authorized Official - Middle Name:YEN
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:281-394-5222
Mailing Address - Street 1:27110 CINCO RANCH BLVD.
Mailing Address - Street 2:STE. 400
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77494
Mailing Address - Country:US
Mailing Address - Phone:281-394-5222
Mailing Address - Fax:281-394-5232
Practice Address - Street 1:27110 CINCO RANCH BLVD.
Practice Address - Street 2:STE. 400
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77494
Practice Address - Country:US
Practice Address - Phone:281-394-5222
Practice Address - Fax:281-394-5232
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-31
Last Update Date:2013-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7415TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB152617Medicare PIN