Provider Demographics
NPI:1376623231
Name:KATY VISION ASSOCIATES, PA
Entity Type:Organization
Organization Name:KATY VISION ASSOCIATES, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SHIROZ
Authorized Official - Middle Name:
Authorized Official - Last Name:VIRANI
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:281-391-2020
Mailing Address - Street 1:23702 WESTHEIMER PKWY
Mailing Address - Street 2:SUITE C
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77494-3605
Mailing Address - Country:US
Mailing Address - Phone:281-391-2020
Mailing Address - Fax:281-391-0786
Practice Address - Street 1:23702 WESTHEIMER PKWY
Practice Address - Street 2:SUITE C
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77494-3605
Practice Address - Country:US
Practice Address - Phone:281-391-2020
Practice Address - Fax:281-391-0786
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-16
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX04038TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0057FGOtherBCBS OF TEXAS
TX04038TGOtherOPTOMETRY LICENSE
TX179586602Medicaid
TX=========OtherTAX IDENTIFICATION NUMBER
TX5872440001Medicare NSC