Provider Demographics
NPI:1013061845
Name:SUN, VISSETT SCOTT (OD)
Entity Type:Individual
Prefix:DR
First Name:VISSETT
Middle Name:SCOTT
Last Name:SUN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:1234 BAY AREA BLVD
Mailing Address - Street 2:SUITE E
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77058-2538
Mailing Address - Country:US
Mailing Address - Phone:281-488-2020
Mailing Address - Fax:281-488-2009
Practice Address - Street 1:1234 BAY AREA BLVD
Practice Address - Street 2:SUITE E
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77058-2538
Practice Address - Country:US
Practice Address - Phone:281-488-2020
Practice Address - Fax:281-488-2009
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2022-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5163TG152WL0500X, 152WP0200X, 152WS0006X, 152WV0400X, 152WX0102X, 152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152WL0500XEye and Vision Services ProvidersOptometristLow Vision Rehabilitation
No152WP0200XEye and Vision Services ProvidersOptometristPediatrics
No152WS0006XEye and Vision Services ProvidersOptometristSports Vision
No152WV0400XEye and Vision Services ProvidersOptometristVision Therapy
No152WX0102XEye and Vision Services ProvidersOptometristOccupational Vision
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX82769EOtherBLUE CROSS BLUE SHIELD
TX117828701Medicaid
TX82769EMedicare PIN