Provider Demographics
| NPI: | 1124308333 |
|---|---|
| Name: | EYERIS VISION CENTER |
| Entity type: | Organization |
| Organization Name: | EYERIS VISION CENTER |
| Other - Org Name: | |
| Other - Org Type: | |
| Authorized Official - Title/Position: | OPTOMETRIST/PRESIDENT |
| Authorized Official - Prefix: | DR |
| Authorized Official - First Name: | BICH NHAT |
| Authorized Official - Middle Name: | TRAN |
| Authorized Official - Last Name: | LE |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | OD |
| Authorized Official - Phone: | 361-219-0266 |
| Mailing Address - Street 1: | 412 LEMONWOOD DR |
| Mailing Address - Street 2: | |
| Mailing Address - City: | KINGSVILLE |
| Mailing Address - State: | TX |
| Mailing Address - Zip Code: | 78363-7541 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 361-219-0266 |
| Mailing Address - Fax: | |
| Practice Address - Street 1: | 9900 S INTERSTATE 35 |
| Practice Address - Street 2: | BUILDING J-34 |
| Practice Address - City: | AUSTIN |
| Practice Address - State: | TX |
| Practice Address - Zip Code: | 78748-3885 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 512-292-9326 |
| Practice Address - Fax: | |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | No |
| Parent Organization LBN: | |
| Parent Organization TIN: | |
| Enumeration Date: | 2011-08-18 |
| Last Update Date: | 2011-10-07 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Licenses
| State | License ID | Taxonomies |
|---|---|---|
| TX | 7374TG | 152W00000X |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 152W00000X | Eye and Vision Services Providers | Optometrist | Group - Single Specialty |