Healthcare Provider Details

I. General information

NPI: 1437331477
Provider Name (Legal Business Name): M & M OPTICAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2007
Last Update Date: 05/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2409 FALCON PASS SUITE 180
HOUSTON TX
77062-6238
US

IV. Provider business mailing address

2409 FALCON PASS SUITE 180
HOUSTON TX
77062-6238
US

V. Phone/Fax

Practice location:
  • Phone: 281-461-3937
  • Fax: 281-461-6084
Mailing address:
  • Phone: 281-461-3937
  • Fax: 281-461-6084

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number4123TG
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License Number4123TG
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code152WS0006X
TaxonomySports Vision Optometrist
License Number4123TG
License Number StateTX
# 4
Primary TaxonomyN
Taxonomy Code152WV0400X
TaxonomyVision Therapy Optometrist
License Number4123TG
License Number StateTX
# 5
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number4123TG
License Number StateTX

VIII. Authorized Official

Name: DR. LISA MARIE MAXWELL-MALIK
Title or Position: DR/OPTOMETRIST
Credential: O.D.
Phone: 281-461-3937