Provider Demographics
NPI:1194890392
Name:NEDERLAND VISION CARE, PC
Entity type:Organization
Organization Name:NEDERLAND VISION CARE, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:DELINO
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:409-721-6897
Mailing Address - Street 1:1617 S HIGHWAY 69
Mailing Address - Street 2:
Mailing Address - City:NEDERLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77627-7839
Mailing Address - Country:US
Mailing Address - Phone:409-721-6897
Mailing Address - Fax:409-729-5947
Practice Address - Street 1:1617 S HIGHWAY 69
Practice Address - Street 2:
Practice Address - City:NEDERLAND
Practice Address - State:TX
Practice Address - Zip Code:77627-7839
Practice Address - Country:US
Practice Address - Phone:409-721-6897
Practice Address - Fax:409-729-5947
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-22
Last Update Date:2007-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4798T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXU43923Medicare UPIN
TX00127SMedicare ID - Type Unspecified