Provider Demographics
NPI:1154507028
Name:VISION OPTIQUE PC
Entity Type:Organization
Organization Name:VISION OPTIQUE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIDGITTE
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:713-838-2020
Mailing Address - Street 1:5158 BUFFALO SPEEDWAY
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77005-4202
Mailing Address - Country:US
Mailing Address - Phone:713-838-2020
Mailing Address - Fax:713-838-2030
Practice Address - Street 1:5158 BUFFALO SPEEDWAY
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77005-4202
Practice Address - Country:US
Practice Address - Phone:713-838-2020
Practice Address - Fax:713-838-2030
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-10
Last Update Date:2010-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5594TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXU79576Medicare UPIN
TXU75635Medicare UPIN
TX00088SMedicare PIN