Provider Demographics
NPI:1750301255
Name:SOUTHERN VISION CENTER, P.A.
Entity Type:Organization
Organization Name:SOUTHERN VISION CENTER, P.A.
Other - Org Name:COPPERFIELD TEXAS STATE OPTICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PERRY
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:SOLI
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:281-550-3600
Mailing Address - Street 1:8506 HIGHWAY 6 N
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77095-2103
Mailing Address - Country:US
Mailing Address - Phone:281-550-3600
Mailing Address - Fax:280-550-3898
Practice Address - Street 1:8506 HIGHWAY 6 N
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77095-2103
Practice Address - Country:US
Practice Address - Phone:281-550-3600
Practice Address - Fax:280-550-3898
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-20
Last Update Date:2009-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4715TG152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX019554701Medicaid
TX0A3224Medicare PIN
TX019554701Medicaid