Provider Demographics
NPI:1982931663
Name:GREENSPOINT VISION CENTER INC.
Entity Type:Organization
Organization Name:GREENSPOINT VISION CENTER INC.
Other - Org Name:VISION SOURCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KHALIL
Authorized Official - Middle Name:NICOLUS
Authorized Official - Last Name:MARCHA
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:281-875-5439
Mailing Address - Street 1:12122 GREENSPOINT DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77060-2002
Mailing Address - Country:US
Mailing Address - Phone:281-875-5439
Mailing Address - Fax:281-875-2266
Practice Address - Street 1:12122 GREENSPOINT DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77060-2002
Practice Address - Country:US
Practice Address - Phone:281-875-5439
Practice Address - Fax:281-875-2266
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-17
Last Update Date:2009-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2085T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0935025-02Medicaid
TX1306925573OtherINDIVIDUAL NPI
TX1982931663OtherGROUP NPI
TXT14591Medicare UPIN