MEDICARE: WILLIAM TRENT TADLOCK O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	7358T	TX

General Provider Information

NPI Number	:	1043443849
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WILLIAM TRENT TADLOCK O.D.

Provider Business Mailing Address
First Line	:	6699 CHIMNEY ROCK RD
Second Line	:	STE. 103
City	:	HOUSTON
State	:	TX
Zip	:	77081-5358
Country	:	US
Telephone Number	:	713-661-6500
Fax Number	:

Provider Business Practice Location Address
First Line	:	6699 CHIMNEY ROCK RD
Second Line	:	STE. 103
City	:	HOUSTON
State	:	TX
Zip	:	77081-5358
Country	:	US
Telephone Number	:	713-661-6500
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/26/2009
Last Update Date	:	08/26/2009

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Directions to “ WILLIAM TRENT TADLOCK O.D.” Practice Location

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