Provider Demographics
NPI:1033496419
Name:BIRDS EYE VIEW OPTOMETRY, PLLC
Entity Type:Organization
Organization Name:BIRDS EYE VIEW OPTOMETRY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:N
Authorized Official - Last Name:BIRD
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:281-347-0004
Mailing Address - Street 1:6734 WESTHEIMER LAKES NORTH DR
Mailing Address - Street 2:SUITE 111
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77494-5712
Mailing Address - Country:US
Mailing Address - Phone:281-347-0004
Mailing Address - Fax:281-574-0030
Practice Address - Street 1:6734 WESTHEIMER LAKES NORTH DR
Practice Address - Street 2:SUITE 111
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77494-5712
Practice Address - Country:US
Practice Address - Phone:281-347-0004
Practice Address - Fax:281-574-0030
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-13
Last Update Date:2012-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7455TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX209343702Medicaid
TX7455TGOtherTEXAS OPTOMETRY LICENSE
TXTXB142478Medicare PIN