Provider Demographics
NPI:1871006965
Name:MANOR VISION PLLC
Entity Type:Organization
Organization Name:MANOR VISION PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONSULTANT
Authorized Official - Prefix:
Authorized Official - First Name:EUDE
Authorized Official - Middle Name:A
Authorized Official - Last Name:OSSORIO
Authorized Official - Suffix:
Authorized Official - Credentials:CONSULTANT
Authorized Official - Phone:832-934-1166
Mailing Address - Street 1:11300 US HIGHWAY 290 E STE 220
Mailing Address - Street 2:
Mailing Address - City:MANOR
Mailing Address - State:TX
Mailing Address - Zip Code:78653-0397
Mailing Address - Country:US
Mailing Address - Phone:512-778-2015
Mailing Address - Fax:512-778-2014
Practice Address - Street 1:11300 US HIGHWAY 290 E STE 220
Practice Address - Street 2:
Practice Address - City:MANOR
Practice Address - State:TX
Practice Address - Zip Code:78653-0397
Practice Address - Country:US
Practice Address - Phone:512-778-2015
Practice Address - Fax:512-778-2014
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-10
Last Update Date:2017-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty