Wavefront Eyecare & Optical PA

Primary specialty

OptometristTaxonomy code 152W00000X

License

7574TG Issued in TX

Legal business name

WAVEFRONT EYECARE & OPTICAL PA

Practice address

1702 Hwy 181 N Suite a-3
Portland, TX 78374-4172

Phone

(832) 419-0773

NPI assigned

Apr 25, 2011

Last updated

May 20, 2011By 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

Hai H Nguyen, O.D.NPI 1518270396

Title

Optometrist

Phone

(832) 419-0773

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

Locations

Practitioners 3

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.

• Hai Hoang Nguyen, O.D.

  • Optometrist
  • Portland, TX
  • NPI 1518270396
  Medicare reassignment NPD Authorized official
• Holli Ann Groff, O.D.

  • Optometrist
  • Houston, TX
  • NPI 1790750867
  Medicare reassignment NPD
• Amber Robin Jordon, O.D.

  • Optometrist
  • Corpus Christi, TX
  • NPI 1487967782
  NPD (past)

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

{
    "created_epoch": "1303689600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1305849600000",
    "number": "1639460629",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1702 HWY 181 N SUITE A-3",
            "city": "PORTLAND",
            "state": "TX",
            "postal_code": "783744172"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1702 HWY 181 N SUITE A-3",
            "city": "PORTLAND",
            "state": "TX",
            "postal_code": "783744172",
            "telephone_number": "832-419-0773"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WAVEFRONT EYECARE & OPTICAL PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-04-25",
        "last_updated": "2011-05-20",
        "status": "A",
        "authorized_official_last_name": "NGUYEN",
        "authorized_official_first_name": "HAI",
        "authorized_official_middle_name": "H",
        "authorized_official_title_or_position": "OPTOMETRIST",
        "authorized_official_telephone_number": "832-419-0773",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": "TX",
            "license": "7574TG",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Amber Leia Waggoner, NP
• Wal-Mart Stores Texas LLC (Walmart Pharmacy)
• Wal-Mart Stores Texas, LLC (Wal-Mart Vision Center 30-5460)
• Walgreen Co (Walgreens #16030)
• Teri Dona Warner, LMT
• West Wharton County Hospital District (Avir at Portland)
• Jennifer White, OTA
• Kimberly Whitlock
• Wilcap Health Services PLLC (Lifetime Vitality Clinic LLC)
• Wildcat Vision PLLC

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 20, 2011; 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.