Provider Demographics
NPI:1457742876
Name:PRECISION VEIN & AESTHETIC CENTER
Entity Type:Organization
Organization Name:PRECISION VEIN & AESTHETIC CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PAIN SPECIALIST
Authorized Official - Prefix:DR
Authorized Official - First Name:OMAR
Authorized Official - Middle Name:
Authorized Official - Last Name:VIDAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD,
Authorized Official - Phone:713-592-6545
Mailing Address - Street 1:6750 WEST LOOP S STE 830
Mailing Address - Street 2:
Mailing Address - City:BELLAIRE
Mailing Address - State:TX
Mailing Address - Zip Code:77401-4117
Mailing Address - Country:US
Mailing Address - Phone:713-592-6545
Mailing Address - Fax:713-751-0605
Practice Address - Street 1:6750 WEST LOOP S STE 830
Practice Address - Street 2:
Practice Address - City:BELLAIRE
Practice Address - State:TX
Practice Address - Zip Code:77401-4117
Practice Address - Country:US
Practice Address - Phone:713-592-6545
Practice Address - Fax:713-751-0605
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-06
Last Update Date:2015-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK8553174400000X
TXK0106174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1083635841OtherPAIN MANAGEMENT CLINIC