MEDICARE: POONAWALA TRADING INC.

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	156FX1800X	Optician	DR3901	TX

General Provider Information

NPI Number	:	1356670707
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	POONAWALA TRADING INC.

Provider Business Mailing Address
First Line	:	11690 SOUTHWEST FWY
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77031-3612
Country	:	US
Telephone Number	:	281-568-1171
Fax Number	:	281-568-3171

Provider Business Practice Location Address
First Line	:	11690 SOUTHWEST FWY
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77031-3612
Country	:	US
Telephone Number	:	281-568-1171
Fax Number	:	281-568-3171

Authorized Official
Title or Position	:	CONTROLLER
Name	:	MR. MUHAMMAD ASIF
Credential	:
Telephone Number	:	281-568-1171

Provider Enumeration Date	:	12/14/2009
Last Update Date	:	12/14/2009

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