Provider Demographics
NPI:1700828308
Name:VISION TRENDS - KINGWOOD PA
Entity Type:Organization
Organization Name:VISION TRENDS - KINGWOOD PA
Other - Org Name:EYE TRENDS AFFILIATE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VISION
Authorized Official - Middle Name:
Authorized Official - Last Name:TRENDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-363-2020
Mailing Address - Street 1:402 SAWDUST RD
Mailing Address - Street 2:
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77380-2243
Mailing Address - Country:US
Mailing Address - Phone:281-363-2020
Mailing Address - Fax:
Practice Address - Street 1:4333 KINGWOOD DR
Practice Address - Street 2:
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77339-3700
Practice Address - Country:US
Practice Address - Phone:281-360-1006
Practice Address - Fax:281-360-2233
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-11
Last Update Date:2022-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX189002201Medicaid
TX00557WMedicare PIN