Provider Demographics
NPI:1619175171
Name:VEGAS, BROOKE (OD)
Entity Type:Individual
Prefix:
First Name:BROOKE
Middle Name:
Last Name:VEGAS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2255 E MOSSY OAKS RD STE 300
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77389-1812
Mailing Address - Country:US
Mailing Address - Phone:713-798-6100
Mailing Address - Fax:
Practice Address - Street 1:2255 E MOSSY OAKS RD STE 300
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77389-1812
Practice Address - Country:US
Practice Address - Phone:713-798-6100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-06
Last Update Date:2021-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2750152W00000X
TX07133TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist