Basic Information
| Provider Information | |||||||||
| NPI: | 1205383783 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | RADIANT EYECARE, PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9814 FRY RD STE 180 | ||||||||
| Address2: | |||||||||
| City: | CYPRESS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 774335373 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8326536066 | ||||||||
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| Practice Location | |||||||||
| Address1: | 9814 FRY RD STE 180 | ||||||||
| Address2: | |||||||||
| City: | CYPRESS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 774335373 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9999999999 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/01/2016 | ||||||||
| LastUpdateDate: | 11/12/2019 | ||||||||
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| AuthorizedOfficialLastName: | NGUYEN | ||||||||
| AuthorizedOfficialFirstName: | MAI | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER OPTOMETRIST | ||||||||
| AuthorizedOfficialTelephone: | 8326536066 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | TX | Y | 193400000X SINGLE SPECIALTY GROUP | Eye and Vision Services Providers | Optometrist |
No ID Information.