Provider Demographics
NPI:1417195330
Name:JULIE K. LY, OD AND ASSOCIATES
Entity Type:Organization
Organization Name:JULIE K. LY, OD AND ASSOCIATES
Other - Org Name:MAXTON VISION GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:K
Authorized Official - Last Name:LY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:281-394-5006
Mailing Address - Street 1:24502 KINGSLAND BLVD
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77494-3429
Mailing Address - Country:US
Mailing Address - Phone:281-589-4263
Mailing Address - Fax:281-589-0999
Practice Address - Street 1:24502 KINGSLAND BLVD
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77494-3429
Practice Address - Country:US
Practice Address - Phone:281-394-5006
Practice Address - Fax:281-589-0999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-30
Last Update Date:2023-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6900TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty