Healthcare Provider Details

I. General information

NPI: 1316083736
Provider Name (Legal Business Name): SAN JACINTO PROFESSIONAL OPTICAL, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4301 GARTH RD SUITE 103
BAYTOWN TX
77521-3153
US

IV. Provider business mailing address

4301 GARTH RD SUITE 103
BAYTOWN TX
77521-3153
US

V. Phone/Fax

Practice location:
  • Phone: 281-427-1147
  • Fax: 281-422-4959
Mailing address:
  • Phone: 281-427-1147
  • Fax: 281-422-4959

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FC0800X
TaxonomyContact Lens Technician/Technologist
License NumberCP00264
License Number StateTX

VIII. Authorized Official

Name: DR. MARTIN J ARISCO
Title or Position: PRESIDENT
Credential: MD
Phone: 281-427-1147