Provider Demographics
NPI:1346375060
Name:MANAGED VISION CARE INC 042793
Entity Type:Organization
Organization Name:MANAGED VISION CARE INC 042793
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:GRADY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:979-299-1878
Mailing Address - Street 1:103 PARKING WAY ST
Mailing Address - Street 2:
Mailing Address - City:LAKE JACKSON
Mailing Address - State:TX
Mailing Address - Zip Code:77566-5228
Mailing Address - Country:US
Mailing Address - Phone:979-299-1878
Mailing Address - Fax:979-297-2395
Practice Address - Street 1:103 PARKING WAY ST
Practice Address - Street 2:
Practice Address - City:LAKE JACKSON
Practice Address - State:TX
Practice Address - Zip Code:77566-5228
Practice Address - Country:US
Practice Address - Phone:979-299-2345
Practice Address - Fax:979-297-2395
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-22
Last Update Date:2010-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX5598930001Medicare NSC