Provider Demographics
NPI:1083882666
Name:QUALITY VISION EYEWEAR
Entity Type:Organization
Organization Name:QUALITY VISION EYEWEAR
Other - Org Name:QUALITY VISION EYEWEAR
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:VALENTINO
Authorized Official - Middle Name:PINEDA
Authorized Official - Last Name:LUNA
Authorized Official - Suffix:JR
Authorized Official - Credentials:OPTICIAN
Authorized Official - Phone:512-462-0001
Mailing Address - Street 1:2800 S IH 35 STE 125
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78704-5707
Mailing Address - Country:US
Mailing Address - Phone:512-462-0001
Mailing Address - Fax:512-462-1926
Practice Address - Street 1:2800 S IH 35 STE 125
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78704-5707
Practice Address - Country:US
Practice Address - Phone:512-462-0001
Practice Address - Fax:512-462-1926
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-15
Last Update Date:2022-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX093573601Medicaid
TX0879400001Medicare PIN
TX093573601Medicaid