1770552176 NPI number — TOMBALL TEXAS STATE OPTICAL PA

Table of content: (NPI 1770552176)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770552176 NPI number — TOMBALL TEXAS STATE OPTICAL PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TOMBALL TEXAS STATE OPTICAL PA
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:
1770552176
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/10/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1250 UVALDE RD
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:
77015-3708
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
28301 TOMBALL PKWY
Provider Second Line Business Practice Location Address:
SUITE #700
Provider Business Practice Location Address City Name:
TOMBALL
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77375-6550
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
281-351-2020
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/16/2006

Additional Information

Authorized Official

Authorized Official Last Name:
FORD
Authorized Official First Name:
THOMAS
Authorized Official Middle Name:
Authorized Official Title or Position:
HR DIRECTOR
Authorized Official Telephone Number:
713-453-2972

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)

  • Identifier: 1583684-01 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com