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General NPI Number Information
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NPI Number | 1003892597
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Entity Type | Organization
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Legal Business Name | RETINA AND VITREOUS OF TEXAS PLLC
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Dates
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Enumeration Date | 12/16/2005
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Last Update Date | 08/21/2024
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Provider Practice Location Address
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Address Line | 6565 WEST LOOP S STE 400
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City | BELLAIRE
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State | TX
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Zip | 77401-3510
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Country | US
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Telephone | 713-799-9975
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Fax | 713-799-1095
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Provider Business Mailing Address
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Address Line | 6565 WEST LOOP S STE 400
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City | BELLAIRE
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State | TX
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Zip | 77401-3510
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Country | US
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Telephone | 713-799-9975
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Fax | 713-799-1095
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Authorized Official
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Title or Position | CEO
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Name | JOSEPH A KHAWLY
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Credential | MD
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Telephone | 713-799-9975
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number |
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License Number State |
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