Provider Demographics
NPI:1043935562
Name:SECOND TEXAS OPTOMETRIC PC
Entity Type:Organization
Organization Name:SECOND TEXAS OPTOMETRIC PC
Other - Org Name:EYETRENDS-WOODLANDS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TAMMI
Authorized Official - Middle Name:
Authorized Official - Last Name:ALLSEP
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:281-513-8100
Mailing Address - Street 1:3333 QUALITY DR
Mailing Address - Street 2:
Mailing Address - City:RANCHO CORDOVA
Mailing Address - State:CA
Mailing Address - Zip Code:95670-7985
Mailing Address - Country:US
Mailing Address - Phone:704-712-0564
Mailing Address - Fax:
Practice Address - Street 1:402 SAWDUST RD
Practice Address - Street 2:
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77380-2243
Practice Address - Country:US
Practice Address - Phone:281-363-2020
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SECOND TEXAS OPTOMETRIC PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-10-06
Last Update Date:2023-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty