1598130577 NPI number — PAMELA EVONNE WILHITE

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598130577 NPI number — PAMELA EVONNE WILHITE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PAMELA EVONNE WILHITE
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:
MAJESTIC OPTICAL
Provider Other Organization Name Type Code:
3
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:
1598130577
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/02/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1919 NORTH LOOP W
Provider Second Line Business Mailing Address:
SUITE 170A
Provider Business Mailing Address City Name:
HOUSTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77008-1374
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
713-802-2020
Provider Business Mailing Address Fax Number:
713-802-2022

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2000 CRAWFORD ST
Provider Second Line Business Practice Location Address:
STE. 100
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77002-9000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
713-659-2020
Provider Business Practice Location Address Fax Number:
713-759-2020
Provider Enumeration Date:
12/02/2015

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
WILHITE
Authorized Official First Name:
PAMELA
Authorized Official Middle Name:
EVONNE
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
713-659-2020

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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