Provider Demographics
NPI:1518330760
Name:VIDA VISION LLC
Entity Type:Organization
Organization Name:VIDA VISION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THANH
Authorized Official - Middle Name:SI
Authorized Official - Last Name:TRUONG
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:832-372-2707
Mailing Address - Street 1:2406 GENTLE BROOK CT
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77062-3235
Mailing Address - Country:US
Mailing Address - Phone:713-795-5881
Mailing Address - Fax:
Practice Address - Street 1:28902 HIGHWAY 290 STE J09
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77433-4296
Practice Address - Country:US
Practice Address - Phone:281-758-1342
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-10
Last Update Date:2016-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6789T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8F7307Medicare PIN