Trinity Vision Center,PA

Primary specialty

OptometristTaxonomy code 152W00000X

License

6310T Issued in TX

Legal business name

TRINITY VISION CENTER,PA

Doing business as

Trinity Vision Center, PA

Practice address

1201 S Main St
Ste 108
Boerne, TX 78006-2833

Phone

(830) 249-3898

Fax

(830) 249-9228

NPI assigned

Jun 4, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Justin M Kim, D.O.

Title

President

Phone

(830) 249-3898

Specialties & licenses 1

Addresses

Other names 1

• Trinity Vision Center, PA Doing business as

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Delesie Petric Johnson, O.D.

  • Optometrist
  • San Antonio, TX
  • NPI 1003032970
  NPD (past)

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

{
    "created_epoch": "1180915200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1448928000000",
    "number": "1861694549",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1201 S MAIN ST",
            "address_2": "STE 108",
            "city": "BOERNE",
            "state": "TX",
            "postal_code": "780062833",
            "telephone_number": "830-249-3898",
            "fax_number": "830-249-9228"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1201 S MAIN ST",
            "address_2": "STE 108",
            "city": "BOERNE",
            "state": "TX",
            "postal_code": "780062833",
            "telephone_number": "830-249-3898",
            "fax_number": "830-249-9228"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TRINITY VISION CENTER,PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-04",
        "last_updated": "2015-12-01",
        "status": "A",
        "authorized_official_last_name": "KIM",
        "authorized_official_first_name": "JUSTIN",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "830-249-3898",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "TX",
            "license": "6310T",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Trinity Vision Center, PA",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Cheryl Ann Trexler, M.D.
• Tricity Pain Associates PA
• Linda Lee Turley, M.A.
• TX-I Medical Services PA
• Ruth Tyler, LVN
• Randi Tyree, LVN
• Zarghoona Khalil Ullah, MD

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 1, 2015; 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.