Oculus Interest XII, LLC

Primary specialty

OptometristTaxonomy code 152W00000X

Legal business name

OCULUS INTEREST XII, LLC

Practice address

20115 Stuebner Airline Rd
Spring, TX 77379-5430

Phone

(561) 275-2020

NPI assigned

Jun 15, 2020

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Jackie Bennett

Title

Credentialing Manager

Phone

(619) 357-6146

Specialties & licenses 2

Addresses

Other names 1

• My EyeLab Doing business as

Tax ID family

My Eyelab2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Oculus Interest XII, LLC

  • Eyewear Supplier
  • Houston, TX
  • NPI 1083230676
  NPD tax ID

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1592179200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1613692800000",
    "number": "1013532068",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20115 STUEBNER AIRLINE RD",
            "city": "SPRING",
            "state": "TX",
            "postal_code": "773795430",
            "telephone_number": "561-275-2020"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20115 STUEBNER AIRLINE RD",
            "city": "SPRING",
            "state": "TX",
            "postal_code": "773795430",
            "telephone_number": "561-275-2020"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OCULUS INTEREST XII, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-06-15",
        "last_updated": "2021-02-19",
        "certification_date": "2021-02-19",
        "status": "A",
        "authorized_official_last_name": "BENNETT",
        "authorized_official_first_name": "JACKIE",
        "authorized_official_title_or_position": "CREDENTIALING MANAGER",
        "authorized_official_telephone_number": "619-357-6146"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "332H00000X",
            "taxonomy_group": "",
            "desc": "Eyewear Supplier",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "My EyeLab",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Victor A Oderinde, M.D.

• Optometrist in Spring, TX
• Providers in Spring, TX by specialty
• Optometrist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 19, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.