Provider Demographics
NPI:1184048407
Name:AN-NUR VISION PA
Entity type:Organization
Organization Name:AN-NUR VISION PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OD/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALINAH
Authorized Official - Middle Name:N
Authorized Official - Last Name:ALI
Authorized Official - Suffix:
Authorized Official - Credentials:OD/OWNER
Authorized Official - Phone:281-240-4448
Mailing Address - Street 1:1480 HIGHWAY 6
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77478-4907
Mailing Address - Country:US
Mailing Address - Phone:281-240-4448
Mailing Address - Fax:281-240-4446
Practice Address - Street 1:1480 HIGHWAY 6
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77478-4907
Practice Address - Country:US
Practice Address - Phone:281-240-4448
Practice Address - Fax:281-240-4446
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-06
Last Update Date:2021-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX340712401Medicaid