MEDICARE: THE LIGHTHOUSE OF HOUSTON

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	332H00000X	Eyewear Supplier
2	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1952501140
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE LIGHTHOUSE OF HOUSTON

Provider Business Mailing Address
First Line	:	3602 W DALLAS ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77019-1704
Country	:	US
Telephone Number	:	713-527-9561
Fax Number	:

Provider Business Practice Location Address
First Line	:	3602 W DALLAS ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77019-1704
Country	:	US
Telephone Number	:	713-527-9561
Fax Number	:

Authorized Official
Title or Position	:	VP CHIEF OPERATIONAL OFFICER
Name	:	SHELAGH K MORAN
Credential	:
Telephone Number	:	713-284-8490

Provider Enumeration Date	:	07/25/2007
Last Update Date	:	07/25/2007

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Directions to “THE LIGHTHOUSE OF HOUSTON ” Practice Location

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