Healthcare Provider Details

I. General information

NPI: 1902342124
Provider Name (Legal Business Name): ELDRIDGE EYE CARE PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2017
Last Update Date: 01/11/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1022 WELDON PARK DR
SUGAR LAND TX
77479-3530
US

IV. Provider business mailing address

1022 WELDON PARK DR
SUGAR LAND TX
77479-3530
US

V. Phone/Fax

Practice location:
  • Phone: 832-934-1166
  • Fax: 832-934-1161
Mailing address:
  • Phone: 832-934-1166
  • Fax: 832-934-1161

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: ALINAH ALI
Title or Position: OD/OWNER
Credential: OD/OWNER
Phone: 832-934-1166