Provider Demographics
NPI:1285979310
Name:NTG VISION, LLC
Entity type:Organization
Organization Name:NTG VISION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:NICOLETTE
Authorized Official - Middle Name:T
Authorized Official - Last Name:GILMORE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:281-421-0599
Mailing Address - Street 1:6502 GARTH RD SUITE 200A
Mailing Address - Street 2:
Mailing Address - City:BAYTOWN
Mailing Address - State:TX
Mailing Address - Zip Code:77521
Mailing Address - Country:US
Mailing Address - Phone:346-230-5126
Mailing Address - Fax:346-230-5127
Practice Address - Street 1:6502 GARTH RD SUITE 200A
Practice Address - Street 2:
Practice Address - City:BAYTOWN
Practice Address - State:TX
Practice Address - Zip Code:77521
Practice Address - Country:US
Practice Address - Phone:346-230-5126
Practice Address - Fax:346-230-5127
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-29
Last Update Date:2023-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX287205YR2LMedicaid