Healthcare Provider Details

I. General information

NPI: 1710527361
Provider Name (Legal Business Name): TSO-ENERGY CORRIDOR PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2020
Last Update Date: 01/12/2020
Certification Date: 01/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14637 MEMORIAL DR STE D
HOUSTON TX
77079-7522
US

IV. Provider business mailing address

14637 MEMORIAL DR STE D
HOUSTON TX
77079-7522
US

V. Phone/Fax

Practice location:
  • Phone: 832-770-4926
  • Fax: 281-493-0043
Mailing address:
  • Phone: 832-770-4926
  • Fax: 281-493-0043

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: EUDE A OSSORIO
Title or Position: CONSULTANT
Credential: CONSULTANT
Phone: 832-934-1166