Healthcare Provider Details

I. General information

NPI: 1831004217
Provider Name (Legal Business Name): ISABELLE PARK OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2026
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10615 FRY RD STE 500
CYPRESS TX
77433-6978
US

IV. Provider business mailing address

2429 FAIRWAY HARBOR DR
KATY TX
77493-5407
US

V. Phone/Fax

Practice location:
  • Phone: 281-393-0023
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number11765
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: