Provider Demographics
NPI:1598059446
Name:CRYSTAL KLEAR OPTICAL
Entity Type:Organization
Organization Name:CRYSTAL KLEAR OPTICAL
Other - Org Name:CRYSTAL KLEAR OPTICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PEARL
Authorized Official - Middle Name:C
Authorized Official - Last Name:OGUCHI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-564-6400
Mailing Address - Street 1:14360 BELLAIRE BLVD STE 132
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77083-7516
Mailing Address - Country:US
Mailing Address - Phone:281-564-6400
Mailing Address - Fax:281-564-6450
Practice Address - Street 1:14360 BELLAIRE BLVD STE 132
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77083-7516
Practice Address - Country:US
Practice Address - Phone:281-564-6400
Practice Address - Fax:281-564-6450
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-07
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
156FX1800X, 332H00000X
TX069591332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332H00000XSuppliersEyewear Supplier
No156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX6495540001Medicare NSC