Provider Demographics
NPI:1588771828
Name:WESTSIDE VISION CENTER
Entity type:Organization
Organization Name:WESTSIDE VISION CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:DILLER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:713-781-5080
Mailing Address - Street 1:11102 BRIAR FOREST DR STE B
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77042-2202
Mailing Address - Country:US
Mailing Address - Phone:713-781-5080
Mailing Address - Fax:713-781-5089
Practice Address - Street 1:11102 BRIAR FOREST DR STE B
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77042-2202
Practice Address - Country:US
Practice Address - Phone:713-781-5080
Practice Address - Fax:713-781-5089
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5702 T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty