Provider Demographics
NPI:1265139885
Name:MITA VALA OD PLLC
Entity type:Organization
Organization Name:MITA VALA OD PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MITA
Authorized Official - Middle Name:
Authorized Official - Last Name:VALA
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:832-279-2470
Mailing Address - Street 1:PO BOX 1304
Mailing Address - Street 2:
Mailing Address - City:BELLAIRE
Mailing Address - State:TX
Mailing Address - Zip Code:77402-1304
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5135 W ALABAMA ST STE 5410
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77056-5814
Practice Address - Country:US
Practice Address - Phone:832-279-2470
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-14
Last Update Date:2023-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty