Provider Demographics
NPI:1063607687
Name:NEUROSENSORY CENTER OF BELLAIRE PA
Entity type:Organization
Organization Name:NEUROSENSORY CENTER OF BELLAIRE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANN
Authorized Official - Middle Name:W
Authorized Official - Last Name:VOSS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:713-664-8090
Mailing Address - Street 1:5001 BISSONNET ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:BELLAIRE
Mailing Address - State:TX
Mailing Address - Zip Code:77401-4025
Mailing Address - Country:US
Mailing Address - Phone:713-664-8090
Mailing Address - Fax:713-664-8078
Practice Address - Street 1:5001 BISSONNET ST
Practice Address - Street 2:SUITE 102
Practice Address - City:BELLAIRE
Practice Address - State:TX
Practice Address - Zip Code:77401-4025
Practice Address - Country:US
Practice Address - Phone:713-664-8090
Practice Address - Fax:713-664-8078
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-06
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4164TG152WV0400X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No152WV0400XEye and Vision Services ProvidersOptometristVision TherapyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX=========OtherTAX IDENTIFICATION NUMBER