Provider Demographics
NPI:1154655108
Name:LONE STAR FAMILY VISION
Entity Type:Organization
Organization Name:LONE STAR FAMILY VISION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CLARENCE
Authorized Official - Middle Name:
Authorized Official - Last Name:WIDMANN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:254-776-3937
Mailing Address - Street 1:533 N VALLEY MILLS DR
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76710-5234
Mailing Address - Country:US
Mailing Address - Phone:254-776-3937
Mailing Address - Fax:
Practice Address - Street 1:533 N VALLEY MILLS DR
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76710-5234
Practice Address - Country:US
Practice Address - Phone:254-776-3937
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-23
Last Update Date:2009-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3751TG332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier