1730613076 NPI number — DECORDOVA EYEWEAR LLC

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 1730613076 NPI number — DECORDOVA EYEWEAR LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DECORDOVA EYEWEAR LLC
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:
1730613076
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/30/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
27390 PENDLETON TRACE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SPRING
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77386-4267
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
281-630-7994
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12230 WEST LAKE HOUSTON PARKWAY
Provider Second Line Business Practice Location Address:
SUITE 155
Provider Business Practice Location Address City Name:
HUMBLE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77044
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
281-763-2006
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/13/2017

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
COOMBS
Authorized Official First Name:
KERR-ANN
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
281-763-2006

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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