Provider Demographics
NPI:1104245216
Name:WOODBRIDGE VISION PLLC
Entity type:Organization
Organization Name:WOODBRIDGE VISION PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:TARUN
Authorized Official - Middle Name:
Authorized Official - Last Name:GANDHI
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:972-563-1600
Mailing Address - Street 1:1005 BILLIE JOHNSON LN
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75044-5253
Mailing Address - Country:US
Mailing Address - Phone:832-671-1218
Mailing Address - Fax:214-722-6997
Practice Address - Street 1:803 WOODBRIDGE PKWY
Practice Address - Street 2:#1400
Practice Address - City:WYLIE
Practice Address - State:TX
Practice Address - Zip Code:75098
Practice Address - Country:US
Practice Address - Phone:972-563-1600
Practice Address - Fax:214-722-6997
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-16
Last Update Date:2014-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7444TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty