Provider Demographics
NPI:1366524324
Name:GMN VISION LLC
Entity type:Organization
Organization Name:GMN VISION LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:K
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:RRT, RPSGT
Authorized Official - Phone:713-384-2956
Mailing Address - Street 1:1018 BECKTON LN
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-7740
Mailing Address - Country:US
Mailing Address - Phone:713-384-2956
Mailing Address - Fax:713-436-6169
Practice Address - Street 1:14570 WALLISVILLE RD
Practice Address - Street 2:SUITE 3B
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77049
Practice Address - Country:US
Practice Address - Phone:713-384-2956
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-19
Last Update Date:2008-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0084702332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0084702OtherMEDICAL DEVICE LICENSE
TX5942500001OtherMEDICARE PTAN
TX0084702OtherMEDICAL DEVICE LICENSE