Provider Demographics
NPI:1174706220
Name:SPACE CITY VISION CENTER
Entity type:Organization
Organization Name:SPACE CITY VISION CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:LOUIS
Authorized Official - Last Name:HALL
Authorized Official - Suffix:JR
Authorized Official - Credentials:OD
Authorized Official - Phone:281-488-8860
Mailing Address - Street 1:17100 GLENMOUNT PARK DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:WEBSTER
Mailing Address - State:TX
Mailing Address - Zip Code:77598-4368
Mailing Address - Country:US
Mailing Address - Phone:281-488-8860
Mailing Address - Fax:281-488-0775
Practice Address - Street 1:17100 GLENMOUNT PARK DR
Practice Address - Street 2:SUITE B
Practice Address - City:WEBSTER
Practice Address - State:TX
Practice Address - Zip Code:77598-4368
Practice Address - Country:US
Practice Address - Phone:281-488-8860
Practice Address - Fax:281-488-0775
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-12
Last Update Date:2007-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2091TG152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXT13633Medicare UPIN
TX00235WMedicare PIN