MEDICARE: PNZ PLACE TSO PC

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1972572378
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PNZ PLACE TSO PC

Provider Business Mailing Address
First Line	:	1250 UVALDE RD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77015-3708
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	711 LOUISIANA ST
Second Line	:	MALL LEVEL
City	:	HOUSTON
State	:	TX
Zip	:	77002-2716
Country	:	US
Telephone Number	:	713-224-2020
Fax Number	:

Authorized Official
Title or Position	:	HR MANAGER
Name	:	MR. THOMAS ANDREW FORD
Credential	:
Telephone Number	:	281-779-8619

Provider Enumeration Date	:	03/16/2006
Last Update Date	:	09/07/2010

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