Provider Demographics
NPI:1255763637
Name:T M VISIONAIRE, PLLC
Entity type:Organization
Organization Name:T M VISIONAIRE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:W. TWELVIS
Authorized Official - Middle Name:T
Authorized Official - Last Name:MATTHEWS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:512-924-6297
Mailing Address - Street 1:404 UNIVERSITY DR E
Mailing Address - Street 2:STE B
Mailing Address - City:COLLEGE STATION
Mailing Address - State:TX
Mailing Address - Zip Code:77840-5905
Mailing Address - Country:US
Mailing Address - Phone:512-924-6297
Mailing Address - Fax:
Practice Address - Street 1:404 UNIVERSITY DR E
Practice Address - Street 2:STE B
Practice Address - City:COLLEGE STATION
Practice Address - State:TX
Practice Address - Zip Code:77840-5905
Practice Address - Country:US
Practice Address - Phone:512-924-6297
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-07
Last Update Date:2013-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8266T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty