Provider Demographics
NPI:1093943292
Name:ALLSEP VISION CENTER PC
Entity Type:Organization
Organization Name:ALLSEP VISION CENTER PC
Other - Org Name:VISION SOURCE PASADENA
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TAMMI
Authorized Official - Middle Name:CUTERET
Authorized Official - Last Name:ALLSEP
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:281-487-8100
Mailing Address - Street 1:5233 FAIRMONT PKWY
Mailing Address - Street 2:SUITE G1
Mailing Address - City:PASADENA
Mailing Address - State:TX
Mailing Address - Zip Code:77505-3947
Mailing Address - Country:US
Mailing Address - Phone:281-487-8100
Mailing Address - Fax:281-487-8103
Practice Address - Street 1:5233 FAIRMONT PKWY
Practice Address - Street 2:SUITE G1
Practice Address - City:PASADENA
Practice Address - State:TX
Practice Address - Zip Code:77505-3947
Practice Address - Country:US
Practice Address - Phone:281-487-8100
Practice Address - Fax:281-487-8103
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-25
Last Update Date:2009-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4765TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0096FFOtherBLUE CROSS BLUE SHIELD
TX0A3988Medicaid
TX0A3988Medicaid