Provider Demographics
NPI:1497748388
Name:VISION CENTER OF MAGNOLIA, P.C.
Entity Type:Organization
Organization Name:VISION CENTER OF MAGNOLIA, P.C.
Other - Org Name:MAGNOLIA VISION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RHONDA
Authorized Official - Middle Name:
Authorized Official - Last Name:MANUEL-SALDIVAR
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:281-259-2020
Mailing Address - Street 1:306 MAGNOLIA BLVD
Mailing Address - Street 2:
Mailing Address - City:MAGNOLIA
Mailing Address - State:TX
Mailing Address - Zip Code:77355-8535
Mailing Address - Country:US
Mailing Address - Phone:281-259-2020
Mailing Address - Fax:281-259-6866
Practice Address - Street 1:306 MAGNOLIA BLVD
Practice Address - Street 2:
Practice Address - City:MAGNOLIA
Practice Address - State:TX
Practice Address - Zip Code:77355-8535
Practice Address - Country:US
Practice Address - Phone:281-259-2020
Practice Address - Fax:281-259-6866
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-25
Last Update Date:2008-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3871TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX465178575OtherTRICARE
TX36FDOtherBCBS
TXDB5070OtherPALMETTO DBA MEDICARE RAILROAD
TX5099410001Medicare NSC
TXDB5070OtherPALMETTO DBA MEDICARE RAILROAD
TX465178575OtherTRICARE