Provider Demographics
NPI:1104840628
Name:BELLAIRE OPTOMETRY CLINIC INC
Entity Type:Organization
Organization Name:BELLAIRE OPTOMETRY CLINIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANNE
Authorized Official - Middle Name:HUYEN
Authorized Official - Last Name:LE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:713-774-3211
Mailing Address - Street 1:8282 BELLAIRE BLVD.
Mailing Address - Street 2:SUITE 162
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77036
Mailing Address - Country:US
Mailing Address - Phone:713-774-3211
Mailing Address - Fax:713-774-2310
Practice Address - Street 1:8282 BELLAIRE BLVD STE 162
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77036-4032
Practice Address - Country:US
Practice Address - Phone:713-774-3211
Practice Address - Fax:713-774-2130
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-27
Last Update Date:2010-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4111T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX082040901Medicaid
TX8F0438Medicare ID - Type Unspecified