Provider Demographics
NPI:1881145019
Name:WISHNOW-SUGAR VISION
Entity type:Organization
Organization Name:WISHNOW-SUGAR VISION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE ASSISTANT
Authorized Official - Prefix:DR
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:A
Authorized Official - Last Name:GOMEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-265-9090
Mailing Address - Street 1:1437 HIGHWAY 6
Mailing Address - Street 2:SUITE 400
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77478-5130
Mailing Address - Country:US
Mailing Address - Phone:281-265-9090
Mailing Address - Fax:281-265-9099
Practice Address - Street 1:1437 HIGHWAY 6
Practice Address - Street 2:SUITE 400
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77478-5130
Practice Address - Country:US
Practice Address - Phone:281-265-9090
Practice Address - Fax:281-265-9099
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-24
Last Update Date:2016-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4348TG152W00000X
TX3741TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXU23816Medicare UPIN
TXU23819Medicare UPIN