Provider Demographics
NPI:1730227869
Name:VISION MAX-BAYTOWN PA
Entity type:Organization
Organization Name:VISION MAX-BAYTOWN PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:PLANTY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:281-421-2020
Mailing Address - Street 1:1819 COMMON ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77009-8628
Mailing Address - Country:US
Mailing Address - Phone:713-598-7268
Mailing Address - Fax:409-932-2597
Practice Address - Street 1:1819 COMMON ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77009-8628
Practice Address - Country:US
Practice Address - Phone:713-598-7268
Practice Address - Fax:409-932-2597
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-01
Last Update Date:2023-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2630T152WP0200X, 152WS0006X, 152WX0102X, 152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Multi-Specialty
No152WP0200XEye and Vision Services ProvidersOptometristPediatricsGroup - Multi-Specialty
No152WS0006XEye and Vision Services ProvidersOptometristSports VisionGroup - Multi-Specialty
No152WX0102XEye and Vision Services ProvidersOptometristOccupational VisionGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX121639202Medicaid
TX827-16EMedicare ID - Type Unspecified