Provider Demographics
NPI:1740536093
Name:MASON VILLAGE OPTICAL, P.C.
Entity type:Organization
Organization Name:MASON VILLAGE OPTICAL, P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NATHAN
Authorized Official - Middle Name:L
Authorized Official - Last Name:LERNER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:281-392-7010
Mailing Address - Street 1:21975 KATY FWY
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77450-1738
Mailing Address - Country:US
Mailing Address - Phone:281-392-7010
Mailing Address - Fax:281-392-6807
Practice Address - Street 1:21975 KATY FWY
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77450-1738
Practice Address - Country:US
Practice Address - Phone:281-392-7010
Practice Address - Fax:281-392-6807
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-24
Last Update Date:2012-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2729-T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXT95914Medicare UPIN