Provider Demographics
NPI:1225319247
Name:PRESTIGE VISION
Entity Type:Organization
Organization Name:PRESTIGE VISION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:ROXY
Authorized Official - Middle Name:
Authorized Official - Last Name:MARKOSE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:214-728-6716
Mailing Address - Street 1:601 S PLANO RD
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75081-4512
Mailing Address - Country:US
Mailing Address - Phone:214-613-5204
Mailing Address - Fax:
Practice Address - Street 1:2317 SOUTHBAY CIR
Practice Address - Street 2:
Practice Address - City:ROWLETT
Practice Address - State:TX
Practice Address - Zip Code:75088-5531
Practice Address - Country:US
Practice Address - Phone:214-728-6716
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-03
Last Update Date:2011-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7707T152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Single Specialty