MEDICARE: IDOCS OD PA

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	TX 7409TG	TX

General Provider Information

NPI Number	:	1073941555
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IDOCS OD PA

Provider Business Mailing Address
First Line	:	2614 ENCLAVE AT SHADY ACRES CT
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77008-1987
Country	:	US
Telephone Number	:	832-338-8688
Fax Number	:

Provider Business Practice Location Address
First Line	:	3450 FM 1960 RD W
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77068-3606
Country	:	US
Telephone Number	:	281-537-0404
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	FRANK LIN
Credential	:	O.D.
Telephone Number	:	281-537-0404

Provider Enumeration Date	:	10/21/2013
Last Update Date	:	10/21/2013

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