Provider Demographics
NPI:1659528362
Name:TODAY'S VISION CONROE, P.A.
Entity Type:Organization
Organization Name:TODAY'S VISION CONROE, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OD
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:M
Authorized Official - Last Name:BREAUX
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:713-995-0042
Mailing Address - Street 1:2257 N LOOP 336 W
Mailing Address - Street 2:SUITE 150
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77304-3566
Mailing Address - Country:US
Mailing Address - Phone:936-788-2600
Mailing Address - Fax:936-788-2601
Practice Address - Street 1:2257 N LOOP 336 W
Practice Address - Street 2:SUITE 150
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77304-3566
Practice Address - Country:US
Practice Address - Phone:936-788-2601
Practice Address - Fax:936-788-2601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-25
Last Update Date:2014-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6887T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX6887TOtherTEXAS OPTOMETRY LICENSE
TX6887TOtherTEXAS OPTOMETRY LICENSE