Provider Demographics
NPI:1144644873
Name:MIRA EYECARE
Entity type:Organization
Organization Name:MIRA EYECARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LOUIS
Authorized Official - Middle Name:ALBERTO
Authorized Official - Last Name:RAMON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:713-926-6567
Mailing Address - Street 1:5819 GULF FWY
Mailing Address - Street 2:SUITE # 700
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77023-5352
Mailing Address - Country:US
Mailing Address - Phone:713-926-6567
Mailing Address - Fax:
Practice Address - Street 1:5819 GULF FWY
Practice Address - Street 2:SUITE # 700
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77023-5352
Practice Address - Country:US
Practice Address - Phone:713-926-6567
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-17
Last Update Date:2014-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6954TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX6954TGOtherSTATE LICENSE
TX211196501Medicaid
TX125169Medicare UPIN