MEDICARE: TEXAS RETINA CENTER, PLLC

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	261QS0132X	Ophthalmologic Surgery Clinic/Center

General Provider Information

NPI Number	:	1265991855
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TEXAS RETINA CENTER, PLLC

Provider Business Mailing Address
First Line	:	2929 WESLAYAN ST APT 1808
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77027-2025
Country	:	US
Telephone Number	:	713-501-2621
Fax Number	:

Provider Business Practice Location Address
First Line	:	2929 WESLAYAN ST APT 1808
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77027-2025
Country	:	US
Telephone Number	:	713-725-8012
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	DR. SHAHEEN CYRUS KAVOUSSI
Credential	:	MD
Telephone Number	:	713-725-8012

Provider Enumeration Date	:	03/13/2019
Last Update Date	:	03/13/2019

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