Provider Demographics
NPI:1073047734
Name:VISION SOURCE - CHAMBERS TOWN CENTER PLLC
Entity Type:Organization
Organization Name:VISION SOURCE - CHAMBERS TOWN CENTER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:H
Authorized Official - Last Name:LAI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-543-5245
Mailing Address - Street 1:8804 N HIGHWAY 146
Mailing Address - Street 2:SUITE #130
Mailing Address - City:BAYTOWN
Mailing Address - State:TX
Mailing Address - Zip Code:77523-9022
Mailing Address - Country:US
Mailing Address - Phone:281-543-5245
Mailing Address - Fax:
Practice Address - Street 1:8804 N HIGHWAY 146
Practice Address - Street 2:SUITE #130
Practice Address - City:BAYTOWN
Practice Address - State:TX
Practice Address - Zip Code:77523-9022
Practice Address - Country:US
Practice Address - Phone:281-543-5245
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-19
Last Update Date:2017-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty