1528187432 NPI number — THE HOUSTON EYE CENTER, P A

Table of content: RALPH A. ODIERNO PAC (NPI 1023440450)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528187432 NPI number — THE HOUSTON EYE CENTER, P A

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE HOUSTON EYE CENTER, P A
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1528187432
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/30/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2855 GRAMERCY ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOUSTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77025-1635
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
713-668-6828
Provider Business Mailing Address Fax Number:
713-558-8785

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2855 GRAMERCY ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77025-1635
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
713-668-6828
Provider Business Practice Location Address Fax Number:
713-558-8785
Provider Enumeration Date:
03/29/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
NIX
Authorized Official First Name:
LINDA
Authorized Official Middle Name:
R.
Authorized Official Title or Position:
CREDENTIALING
Authorized Official Telephone Number:
713-558-8728

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  6497TG , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)