Provider Demographics
NPI:1508146374
Name:OPTICAL ILLUSIONZ INC
Entity Type:Organization
Organization Name:OPTICAL ILLUSIONZ INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JONNY
Authorized Official - Middle Name:
Authorized Official - Last Name:FUENTES
Authorized Official - Suffix:
Authorized Official - Credentials:ABOC
Authorized Official - Phone:713-771-7867
Mailing Address - Street 1:5800 BELLAIRE BLVD
Mailing Address - Street 2:STE 112
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77081-5537
Mailing Address - Country:US
Mailing Address - Phone:713-771-7867
Mailing Address - Fax:713-771-7869
Practice Address - Street 1:5800 BELLAIRE BLVD
Practice Address - Street 2:STE 112
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77081-5537
Practice Address - Country:US
Practice Address - Phone:713-771-7867
Practice Address - Fax:713-771-7869
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-24
Last Update Date:2015-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty