MEDICARE: MARK D. PICKERING O.D.

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	174400000X	Specialist	03084TG	TX

General Provider Information

NPI Number	:	1548310725
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARK D. PICKERING O.D.

Provider Business Mailing Address
First Line	:	2518 RICHMOND AVE
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77098-3209
Country	:	US
Telephone Number	:	713-995-0042
Fax Number	:	713-995-0548

Provider Business Practice Location Address
First Line	:	2518 RICHMOND AVE
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77098-3209
Country	:	US
Telephone Number	:	713-995-0042
Fax Number	:	713-995-0548

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

Provider Enumeration Date	:	01/11/2007
Last Update Date	:	07/08/2007

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