Provider Demographics
NPI:1952791204
Name:IDEAL VISION, P.A.
Entity Type:Organization
Organization Name:IDEAL VISION, P.A.
Other - Org Name:IDEAL EYECARE & OPTICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HOAN
Authorized Official - Middle Name:
Authorized Official - Last Name:LE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:817-616-5000
Mailing Address - Street 1:7216 GLENVIEW DR
Mailing Address - Street 2:
Mailing Address - City:RICHLAND HILLS
Mailing Address - State:TX
Mailing Address - Zip Code:76180-8612
Mailing Address - Country:US
Mailing Address - Phone:817-616-5000
Mailing Address - Fax:
Practice Address - Street 1:7216 GLENVIEW DR
Practice Address - Street 2:
Practice Address - City:RICHLAND HILLS
Practice Address - State:TX
Practice Address - Zip Code:76180-8612
Practice Address - Country:US
Practice Address - Phone:817-616-5000
Practice Address - Fax:817-284-8779
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-26
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5911TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX347219303Medicaid
TX347219301Medicaid