Provider Demographics
NPI:1043606197
Name:OPTICAL EDGE
Entity Type:Organization
Organization Name:OPTICAL EDGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:REGINA
Authorized Official - Middle Name:THUY VY
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:281-984-7515
Mailing Address - Street 1:14870 SPACE CENTER BLVD
Mailing Address - Street 2:SUITE H
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77062-2368
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:14870 SPACE CENTER BLVD
Practice Address - Street 2:SUITE H
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77062-2368
Practice Address - Country:US
Practice Address - Phone:281-984-7515
Practice Address - Fax:855-751-5551
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-15
Last Update Date:2017-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7262TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty