Provider Demographics
NPI:1033773023
Name:VISION PARK SURGERY CENTER, LLC
Entity Type:Organization
Organization Name:VISION PARK SURGERY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ERWIN
Authorized Official - Middle Name:
Authorized Official - Last Name:LO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-845-3378
Mailing Address - Street 1:111 VISION PARK BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:SHENANDOAH
Mailing Address - State:TX
Mailing Address - Zip Code:77384-3006
Mailing Address - Country:US
Mailing Address - Phone:281-845-3378
Mailing Address - Fax:936-267-3166
Practice Address - Street 1:111 VISION PARK BLVD STE 200
Practice Address - Street 2:
Practice Address - City:SHENANDOAH
Practice Address - State:TX
Practice Address - Zip Code:77384-3006
Practice Address - Country:US
Practice Address - Phone:281-845-3378
Practice Address - Fax:936-267-3166
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-25
Last Update Date:2020-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical