Provider Demographics
NPI:1407986771
Name:OMNIVISION EYE CARE PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:OMNIVISION EYE CARE PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THOAI
Authorized Official - Middle Name:PETER
Authorized Official - Last Name:BUI
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:972-939-5367
Mailing Address - Street 1:4112 N JOSEY LN
Mailing Address - Street 2:STE 112
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75007-1509
Mailing Address - Country:US
Mailing Address - Phone:972-939-5367
Mailing Address - Fax:
Practice Address - Street 1:4112 N JOSEY LN
Practice Address - Street 2:STE 112
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75007-1509
Practice Address - Country:US
Practice Address - Phone:972-939-5367
Practice Address - Fax:972-939-5365
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2011-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6571TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXV04202Medicare UPIN