Provider Demographics
NPI:1457308306
Name:VISION SOURCE - ATASCOCITA, P.A.
Entity Type:Organization
Organization Name:VISION SOURCE - ATASCOCITA, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JANET
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:BLOCK
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:281-728-9798
Mailing Address - Street 1:11928 SIMMONS DR
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:TX
Mailing Address - Zip Code:77328-7202
Mailing Address - Country:US
Mailing Address - Phone:281-728-9798
Mailing Address - Fax:
Practice Address - Street 1:5514 ATASCOCITA RD
Practice Address - Street 2:SUITE 100
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77346-2837
Practice Address - Country:US
Practice Address - Phone:281-548-2020
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-27
Last Update Date:2008-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX05030TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty