Healthcare Provider Details

I. General information

NPI: 1083095921
Provider Name (Legal Business Name): JERRY CAO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2015
Last Update Date: 05/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19433 MORRIS AVE STE 110
MANVEL TX
77578
US

IV. Provider business mailing address

2825 PARKSIDE VILLAGE CT
PEARLAND TX
77581-3811
US

V. Phone/Fax

Practice location:
  • Phone: 346-978-0713
  • Fax:
Mailing address:
  • Phone: 346-978-0713
  • Fax: 346-299-9048

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number8649T
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: