Provider Demographics
NPI:1750566733
Name:ELITE VISION CARE, PLLC
Entity type:Organization
Organization Name:ELITE VISION CARE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TABITHA
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-554-7080
Mailing Address - Street 1:1615 W LEAGUE CITY PKWY STE 100
Mailing Address - Street 2:
Mailing Address - City:LEAGUE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77573-7458
Mailing Address - Country:US
Mailing Address - Phone:281-554-7080
Mailing Address - Fax:281-554-3700
Practice Address - Street 1:1615 W LEAGUE CITY PKWY STE 100
Practice Address - Street 2:
Practice Address - City:LEAGUE CITY
Practice Address - State:TX
Practice Address - Zip Code:77573-7458
Practice Address - Country:US
Practice Address - Phone:281-554-7080
Practice Address - Fax:281-554-3700
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-08
Last Update Date:2024-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6234TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB126538Medicare PIN