Provider Demographics
NPI:1336262278
Name:EYE MAX
Entity type:Organization
Organization Name:EYE MAX
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:NGO
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:713-722-9066
Mailing Address - Street 1:1343 S VOSS RD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77057-1023
Mailing Address - Country:US
Mailing Address - Phone:713-722-9066
Mailing Address - Fax:713-722-0690
Practice Address - Street 1:1343 S VOSS RD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77057-1023
Practice Address - Country:US
Practice Address - Phone:713-722-9066
Practice Address - Fax:713-722-0690
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-07
Last Update Date:2007-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX5452100001OtherPALMETTO SUPPLIER #
TXU91199Medicare UPIN
TX00069ZMedicare PIN