Healthcare Provider Details

I. General information

NPI: 1982180410
Provider Name (Legal Business Name): CONNIE CHOUA OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2018
Last Update Date: 07/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19511 INTERSTATE 45 N
SPRING TX
77388-6015
US

IV. Provider business mailing address

12707 BOHEME DR APT 1310
HOUSTON TX
77024-5538
US

V. Phone/Fax

Practice location:
  • Phone: 281-288-4447
  • Fax:
Mailing address:
  • Phone: 469-952-8936
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number9420
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: