Provider Demographics
NPI:1598056855
Name:PEARLAND PROFESSIONAL VISION PLLC
Entity Type:Organization
Organization Name:PEARLAND PROFESSIONAL VISION PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER-OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:AMIE
Authorized Official - Middle Name:SUSSAN
Authorized Official - Last Name:GISBERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-997-2015
Mailing Address - Street 1:9215 BROADWAY ST
Mailing Address - Street 2:SUITE 119
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-8987
Mailing Address - Country:US
Mailing Address - Phone:281-997-2015
Mailing Address - Fax:281-997-2016
Practice Address - Street 1:9215 BROADWAY ST
Practice Address - Street 2:SUITE 119
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77584-8987
Practice Address - Country:US
Practice Address - Phone:281-997-2015
Practice Address - Fax:281-997-2016
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-21
Last Update Date:2013-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7400TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB130555Medicare PIN