Vision Source - Kingwood, PA

Primary specialty

OptometristTaxonomy code 152W00000X

License

03337TG Issued in TX

Legal business name

VISION SOURCE - KINGWOOD, PA

Practice address

1714 Kingwood Dr
Kingwood, TX 77339-3046

Phone

(713) 995-0042

Fax

(713) 995-0548

NPI assigned

Mar 10, 2007

Last updated

Jun 21, 2018By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Glenn D. Ellisor, O.D.NPI 1407900590

Title

President

Phone

(713) 995-0042

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

Locations

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Glenn D Ellisor, O.D.

  • Corneal and Contact Management Optometrist
  • Kingwood, TX
  • NPI 1407900590
  Medicare reassignment Care Compare group NPD Authorized official
• Christine Elizabeth Acosta, O.D.

  • Optometrist
  • Kingwood, TX
  • NPI 1194897231
  Medicare reassignment Care Compare group NPD
• Keith Russell Danz, O.D.

  • Optometrist
  • Kingwood, TX
  • NPI 1609958990
  Medicare reassignment Care Compare group NPD
• Erin C Ellisor, OD

  • Optometrist
  • Kingwood, TX
  • NPI 1790262475
  Medicare reassignment Care Compare group NPD
• Wade Ellisor, OD

  • Optometrist
  • Kingwood, TX
  • NPI 1497138572
  Medicare reassignment Care Compare group NPD
• Catherine M Khalaf, OD

  • Optometrist
  • Kingwood, TX
  • NPI 1881583854
  Medicare reassignment Care Compare group NPD
• Richardson Hoang Pham, OD

  • Optometrist
  • Houston, TX
  • NPI 1457923054
  Medicare reassignment NPD

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

{
    "created_epoch": "1173484800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1529539200000",
    "number": "1265564769",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1714 KINGWOOD DR",
            "city": "KINGWOOD",
            "state": "TX",
            "postal_code": "773393046",
            "telephone_number": "713-995-0042",
            "fax_number": "713-995-0548"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1714 KINGWOOD DR",
            "city": "KINGWOOD",
            "state": "TX",
            "postal_code": "773393046",
            "telephone_number": "713-995-0042",
            "fax_number": "713-995-0548"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VISION SOURCE - KINGWOOD, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-10",
        "last_updated": "2018-06-21",
        "status": "A",
        "authorized_official_last_name": "ELLISOR",
        "authorized_official_first_name": "GLENN",
        "authorized_official_middle_name": "D.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "713-995-0042",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "TX",
            "license": "03337TG",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS & BLUE SHIELD",
            "identifier": "0046FE",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Ayana Villanueva, RBT
• Susette Marie Villegas, LCSW
• Ashlyne Paige Vineyard, MAT, LAT, ATC
• Vip Health Services, LLC. (Kingwood Urgent Care & Special Clinic)
• Daniel Visaya, MD
• Vital Healthcare, LLC
• Vital Holdings, Inc. (Vital Healthcare, Inc.)
• Vital Infusion LLC
• Vitality Health Services, PLLC
• Jennifer Votaw

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 21, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.