=====================================================
General NPI Number Information
=====================================================
NPI Number | 1114156296
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | PAIGE A. CHUMLEY O.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/09/2009
-----------------------------------------------------
Last Update Date | 01/18/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 21318 PROVINCIAL BLVD
-----------------------------------------------------
City | KATY
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77450-7580
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-398-0747
-----------------------------------------------------
Fax | 281-398-9825
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 296
-----------------------------------------------------
City | KATY
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77492-0296
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-259-1115
-----------------------------------------------------
Fax | 281-391-3316
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 7369T
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------