1912016171 NPI number — COMFORT EYECARE, P.A.

Table of content: (NPI 1912016171)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912016171 NPI number — COMFORT EYECARE, P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COMFORT EYECARE, 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:
6
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:
1912016171
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3311 ALMOND CREEK DR
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:
77059-2815
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
281-286-9086
Provider Business Mailing Address Fax Number:
281-334-8849

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
255 FM 518 RD
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
KEMAH
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77565-3219
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
281-334-8848
Provider Business Practice Location Address Fax Number:
281-334-8849
Provider Enumeration Date:
08/30/2006

Additional Information

Authorized Official

Authorized Official Last Name:
PHAM
Authorized Official First Name:
JULIE
Authorized Official Middle Name:
Authorized Official Title or Position:
DOCTOR OF OPTOMETRY/OWNER
Authorized Official Telephone Number:
281-286-9086

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  6098T , 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)

  • Identifier: 919769 . This is a "BLOCK VISION" identifier . This identifiers is of the category "OTHER".
  • Identifier: 14310 . This is a "SPECTERA" identifier . This identifiers is of the category "OTHER".




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