Provider Demographics
NPI:1245494640
Name:BELLA VISION PLLC.
Entity type:Organization
Organization Name:BELLA VISION PLLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THI
Authorized Official - Middle Name:TRUONG
Authorized Official - Last Name:LE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:512-454-1900
Mailing Address - Street 1:1206 WEST 38TH STREET
Mailing Address - Street 2:1204A
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78705-1018
Mailing Address - Country:US
Mailing Address - Phone:512-454-1900
Mailing Address - Fax:512-206-4402
Practice Address - Street 1:1206 WEST 38TH STREET
Practice Address - Street 2:1204A
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78705-1018
Practice Address - Country:US
Practice Address - Phone:512-454-1900
Practice Address - Fax:512-206-4402
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-15
Last Update Date:2016-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX00682T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0019FGOtherBCBS