Healthcare Provider Details

I. General information

NPI: 1386045755
Provider Name (Legal Business Name): WENDY KUO OD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/04/2014
Last Update Date: 01/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18700 HIGHWAY 105 W
MONTGOMERY TX
77356-5625
US

IV. Provider business mailing address

40 BECKONVALE CT
SPRING TX
77382-2652
US

V. Phone/Fax

Practice location:
  • Phone: 936-582-1120
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number7178TG
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: