Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152WC0802X | Optomitrist - Corneal and Contact Lenses | 5163TG | TX |
N | 152WL0500X | Optomitrist - Low Vision Rehabilitation | 5163TG | TX |
N | 152WP0200X | Pediatric Optomitrist | 5163TG | TX |
N | 152WS0006X | Sports Vision | 5163TG | TX |
N | 152WV0400X | Optomitrist - Vision Therapist | 5163TG | TX |
N | 152WX0102X | Occupational Vision | 5163TG | TX |
NPI | 1013061845 |
---|---|
Provider Name | Dr. Vissett Scott Sun |
First Address | Houston, TX 77058-2538 |
Second Address | Houston, TX 77058-2538 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/01/2007 |
Last Update Date | 17/12/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
82769E | BLUE CROSS BLUE SHIELD (01) | TX |
U57061 | (02) | TX |