VISION SOURCE - KINGWOOD, PA
NPI 1265564769
Optometrist in Kingwood, TX
About Vision Source - Kingwood, Pa NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
VISION SOURCE - KINGWOOD, PA (NPI 1265564769) is a healthcare organization registered as an optometrist in Kingwood, Texas and active in the NPI registry since March 2007. The organization lists Glenn D. Ellisor, President, as its authorized official.
NPPES Registry Identity
Specialties & Licenses
Other Identifiers 1
Group Practice 1
Accepted Insurance
Medicare Participation & PECOS CMS
Medicare enrollment, revalidation and the clinicians who bill Medicare through this organization, from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Vision Source - Kingwood, Pa is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Medicare Revalidation Due Date
Revalidation due by October 31, 2026
Medicare-enrolled providers and suppliers confirm their enrollment information with CMS on a set cycle, every 5 years for most and every 3 years for medical equipment suppliers. CMS sets the due date for each enrollment.
Clinicians Billing Medicare Through This Organization
6Medicare enrollment records show 6 clinicians reassign Medicare billing to Vision Source - Kingwood, PA, which bills Medicare for the services they deliver. Of these, 5 practice at this address. They are listed nearest first.
Clinicians, nearest first (6)
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Frequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
What is Vision Source - Kingwood, PA's NPI number?
The NPI number for Vision Source - Kingwood, PA is 1265564769. It was assigned to this organization in the NPPES registry on March 10, 2007.
Where is Vision Source - Kingwood, PA located?
Vision Source - Kingwood, PA is located at 1714 Kingwood Dr, Kingwood, TX 77339. The listed phone number is (713) 995-0042.
What is Vision Source - Kingwood, PA's specialty?
The primary specialty registered for this NPI is Optometrist with taxonomy code 152W00000X.
Is Vision Source - Kingwood, PA enrolled in Medicare?
Yes. Vision Source - Kingwood, PA is registered in the Medicare PECOS enrollment system.
When is Vision Source - Kingwood, PA's Medicare revalidation due?
According to the CMS Revalidation Due Date List (October 2026 release), the Medicare Non-DME Part B enrollment for this organization (Texas, Clinic/Group Practice) is due for revalidation by October 31, 2026. Medicare providers and suppliers revalidate their enrollment every 5 years, and medical equipment suppliers every 3 years. Confirm current requirements with your Medicare Administrative Contractor.
How many clinicians bill Medicare through Vision Source - Kingwood, PA?
According to the CMS Revalidation Reassignment List (October 2026 release), 6 clinicians, all in Optometry, reassign their Medicare billing to Vision Source - Kingwood, PA. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Of these, 5 practice at this address. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
What insurance does Vision Source - Kingwood, PA accept?
Health plans from Ambetter Health, Ambetter from Arizona Complete Health, Ambetter from Arkansas Health & Wellness, Ambetter from Louisiana Healthcare Connections and Ambetter from Superior HealthPlan and 6 other insurers list Vision Source - Kingwood, PA as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.
When was this NPI record last updated?
The NPPES record for Vision Source - Kingwood, PA was last updated on June 21, 2018. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 8 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.
# Vision Source - Kingwood, Pa · NPI 1265564769
Optometrist organization in Kingwood, Texas. Organization record, active in the CMS NPPES registry since March 10, 2007.
## Identity
- **NPI:** 1265564769 (Entity type: Organization)
- **Enumerated:** March 10, 2007
- **Primary specialty:** Optometrist · taxonomy 152W00000X
- **Organization subpart:** No
- **Authorized official:** Glenn Ellisor, PRESIDENT
## Practice location
- **Address:** 1714 KINGWOOD DR, Kingwood, TX 77339-3046
- **Phone:** (713) 995-0042 · **Fax:** (713) 995-0548
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Medicare revalidation due:** October 31, 2026 (Non-DME Part B, Texas, Clinic/Group Practice) · CMS Revalidation Due Date List, October 2026 release
- **Clinicians billing through this organization:** 6 clinicians (Optometry) reassign Medicare billing to this organization (form CMS-855R); 5 practice at this address · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** June 21, 2018
- **Other identifiers:** Other 0046FE (TX)
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Source: [NPI Profile](https://npiprofile.com/npi/1265564769) · Data from the CMS NPPES public registry.