MEDICARE: M & M OPTICAL 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	152WC0802X	Corneal and Contact Management Optometrist	4123TG	TX
2	152WP0200X	Pediatric Optometrist	4123TG	TX
3	152WS0006X	Sports Vision Optometrist	4123TG	TX
4	152WV0400X	Vision Therapy Optometrist	4123TG	TX
5	152W00000X	Optometrist	4123TG	TX

General Provider Information

NPI Number	:	1437331477
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	M & M OPTICAL INC

Provider Business Mailing Address
First Line	:	2409 FALCON PASS
Second Line	:	SUITE 180
City	:	HOUSTON
State	:	TX
Zip	:	77062-6238
Country	:	US
Telephone Number	:	281-461-3937
Fax Number	:	281-461-6084

Provider Business Practice Location Address
First Line	:	2409 FALCON PASS
Second Line	:	SUITE 180
City	:	HOUSTON
State	:	TX
Zip	:	77062-6238
Country	:	US
Telephone Number	:	281-461-3937
Fax Number	:	281-461-6084

Authorized Official
Title or Position	:	DR/OPTOMETRIST
Name	:	DR. LISA MARIE MAXWELL-MALIK
Credential	:	O.D.
Telephone Number	:	281-461-3937

Provider Enumeration Date	:	12/01/2007
Last Update Date	:	05/01/2013

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Directions to “M & M OPTICAL INC ” Practice Location

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