Provider Demographics
NPI:1043488323
Name:THE LOOKING GLASS OPTIQUE PC
Entity Type:Organization
Organization Name:THE LOOKING GLASS OPTIQUE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:VU
Authorized Official - Middle Name:
Authorized Official - Last Name:LAM
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:972-966-3937
Mailing Address - Street 1:2600 VILLAGE PARKWAY
Mailing Address - Street 2:UNIT 1A
Mailing Address - City:HIGHLAND VILLAGE
Mailing Address - State:TX
Mailing Address - Zip Code:75077
Mailing Address - Country:US
Mailing Address - Phone:972-966-3937
Mailing Address - Fax:972-966-3938
Practice Address - Street 1:2600 VILLAGE PARKWAY
Practice Address - Street 2:UNIT 1A
Practice Address - City:HIGHLAND VILLAGE
Practice Address - State:TX
Practice Address - Zip Code:75077
Practice Address - Country:US
Practice Address - Phone:972-966-3937
Practice Address - Fax:972-966-3938
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-20
Last Update Date:2008-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6490T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty