Provider Demographics
NPI:1558426387
Name:VISION CENTERS OF HOUSTON WILLOWBROOK PLLC
Entity Type:Organization
Organization Name:VISION CENTERS OF HOUSTON WILLOWBROOK PLLC
Other - Org Name:FAMILY EYE CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:PARKER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:832-764-7809
Mailing Address - Street 1:17282 S.H. 249, F.M. 1960
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77064
Mailing Address - Country:US
Mailing Address - Phone:281-995-9999
Mailing Address - Fax:713-995-0548
Practice Address - Street 1:17282 S.H. 249, F.M. 1960
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77064
Practice Address - Country:US
Practice Address - Phone:281-995-9999
Practice Address - Fax:713-995-0548
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-22
Last Update Date:2021-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3077TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX3077TGOtherTEXAS OPTOMETRY LICENSE
TX=========OtherTAX IDENTIFICATION NUMBER
TXC21705Medicare UPIN
TX00508VMedicare PIN