Provider Demographics
NPI:1407143076
Name:WESTSIDE EYE CARE
Entity Type:Organization
Organization Name:WESTSIDE EYE CARE
Other - Org Name:WESTSIDE EYE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THAO
Authorized Official - Middle Name:THIEN
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:281-235-5442
Mailing Address - Street 1:PO BOX 8176
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77288-8176
Mailing Address - Country:US
Mailing Address - Phone:281-235-5443
Mailing Address - Fax:
Practice Address - Street 1:1560 ELDRIDGE PKWY
Practice Address - Street 2:SUITE 136
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77077-1761
Practice Address - Country:US
Practice Address - Phone:281-235-5443
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-05
Last Update Date:2011-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX7728TGOtherTEXAS OPTOMETRY LICENSE