Provider Demographics
NPI:1669667713
Name:VISION QUEST PA
Entity Type:Organization
Organization Name:VISION QUEST PA
Other - Org Name:CYPRESS RANCH VISION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:NHU
Authorized Official - Last Name:MAI
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:281-393-0023
Mailing Address - Street 1:10615 FRY RD STE 500
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77433-6978
Mailing Address - Country:US
Mailing Address - Phone:832-483-6952
Mailing Address - Fax:832-653-2439
Practice Address - Street 1:10615 FRY RD STE 500
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77433-6978
Practice Address - Country:US
Practice Address - Phone:281-393-0023
Practice Address - Fax:832-653-2439
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-12
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX07006TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX=========OtherTAX IDENTIFICATION NUMBER