Basic Information
| Provider Information | |||||||||
| NPI: | 1649371782 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | TODAY'S VISION - DEERBROOK, P.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 20811 HIGHWAY 59 N STE 300 | ||||||||
| Address2: | |||||||||
| City: | HUMBLE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 773382260 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2814462020 | ||||||||
| FaxNumber: | 2815483411 | ||||||||
| Practice Location | |||||||||
| Address1: | 20811 HIGHWAY 59 N STE 300 | ||||||||
| Address2: | |||||||||
| City: | HUMBLE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 773382260 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2814462020 | ||||||||
| FaxNumber: | 2815483411 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/25/2006 | ||||||||
| LastUpdateDate: | 05/18/2010 | ||||||||
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| AuthorizedOfficialLastName: | PRAVDA | ||||||||
| AuthorizedOfficialFirstName: | JAY | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER / PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 2814462020 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | O.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 2295T | TX | Y | 193400000X SINGLE SPECIALTY GROUP | Eye and Vision Services Providers | Optometrist |
ID Information
| ID | Type | State | Issuer | Description | 155717501 | 05 | TX | MEDICAID |