Provider Demographics
NPI:1710172044
Name:COPPERFIELD VISION CENTER, INC
Entity Type:Organization
Organization Name:COPPERFIELD VISION CENTER, INC
Other - Org Name:PEARLE VISION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CATHERINE
Authorized Official - Middle Name:D
Authorized Official - Last Name:ONG
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:281-463-8333
Mailing Address - Street 1:7085 HIGHWAY 6 N
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77095-2505
Mailing Address - Country:US
Mailing Address - Phone:281-463-8333
Mailing Address - Fax:281-463-8727
Practice Address - Street 1:7085 HIGHWAY 6 N
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77095-2505
Practice Address - Country:US
Practice Address - Phone:281-463-8333
Practice Address - Fax:281-463-8727
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-10
Last Update Date:2014-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5441TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1616054-01Medicaid
TX00141UMedicare UPIN
TX8598B9Medicare PIN