MEDICARE: DR. TIHOMIRA PETKOVA - VAMVAKA O.D, PH.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	152W00000X	Optometrist	8626TG	TX

General Provider Information

NPI Number	:	1790158855
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TIHOMIRA PETKOVA - VAMVAKA O.D, PH.D.

Provider Business Mailing Address
First Line	:	4310 DUNLAVY ST
Second Line	:	APT.350
City	:	HOUSTON
State	:	TX
Zip	:	77006-5292
Country	:	US
Telephone Number	:	832-202-4780
Fax Number	:

Provider Business Practice Location Address
First Line	:	4310 DUNLAVY ST
Second Line	:	APT.350
City	:	HOUSTON
State	:	TX
Zip	:	77006-5292
Country	:	US
Telephone Number	:	832-202-4780
Fax Number	:

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

Provider Enumeration Date	:	11/10/2015
Last Update Date	:	01/01/2017

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