MEDICARE: DR. EVAN L MAPES OD

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	4834T	TX

General Provider Information

NPI Number	:	1376861211
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EVAN L MAPES OD

Provider Business Mailing Address
First Line	:	4317 MONTROSE BLVD
Second Line	:	#2
City	:	HOUSTON
State	:	TX
Zip	:	77006-5862
Country	:	US
Telephone Number	:	713-529-3937
Fax Number	:	713-529-0181

Provider Business Practice Location Address
First Line	:	4317 MONTROSE BLVD
Second Line	:	#2
City	:	HOUSTON
State	:	TX
Zip	:	77006-5862
Country	:	US
Telephone Number	:	713-529-3937
Fax Number	:	713-529-0181

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

Provider Enumeration Date	:	05/15/2010
Last Update Date	:	05/15/2010

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