Provider Demographics
NPI:1871185926
Name:FLASH EYEWEAR AND REPAIR LLC
Entity Type:Organization
Organization Name:FLASH EYEWEAR AND REPAIR LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:MARIO
Authorized Official - Middle Name:
Authorized Official - Last Name:SANTILLAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-288-2661
Mailing Address - Street 1:13713 STATE HIGHWAY 249
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77086-2705
Mailing Address - Country:US
Mailing Address - Phone:832-288-2661
Mailing Address - Fax:800-261-5036
Practice Address - Street 1:13713 STATE HIGHWAY 249
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77086-2705
Practice Address - Country:US
Practice Address - Phone:832-288-2661
Practice Address - Fax:800-261-5036
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-10
Last Update Date:2021-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX391391501Medicaid