Healthcare Provider Details

I. General information

NPI: 1578963682
Provider Name (Legal Business Name): MAVIS DAO O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/26/2014
Last Update Date: 08/19/2021
Certification Date: 08/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10961 NORTH FWY STE 102A
HOUSTON TX
77037-1139
US

IV. Provider business mailing address

3206 E CEDAR HOLLOW DR
PEARLAND TX
77584-8125
US

V. Phone/Fax

Practice location:
  • Phone: 281-445-2015
  • Fax:
Mailing address:
  • Phone: 832-606-5761
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number270A00656100
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number8473TG
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: