Provider Demographics
NPI:1932622537
Name:VISION TRENDS - SOUTH LAKE
Entity Type:Organization
Organization Name:VISION TRENDS - SOUTH LAKE
Other - Org Name:EYE TRENDS - SOUTH LAKE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPTOMETRIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:J
Authorized Official - Last Name:STERITZ
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:936-537-1180
Mailing Address - Street 1:406 SAWDUST RD
Mailing Address - Street 2:
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77380-2243
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1021 E SOUTHLAKE BLVD
Practice Address - Street 2:
Practice Address - City:SOUTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76092-6347
Practice Address - Country:US
Practice Address - Phone:936-537-1180
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EYE TRENDS - SOUTH LAKE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-07-25
Last Update Date:2017-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX09257152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty