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General NPI Number Information
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NPI Number | 1154405777
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Entity Type | Organization
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Legal Business Name | TSO-BAYBROOK, P.A.
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Dates
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Enumeration Date | 10/24/2006
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Last Update Date | 07/18/2018
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Provider Practice Location Address
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Address Line | 19052 GULF FWY
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City | FRIENDSWOOD
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State | TX
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Zip | 77546
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Country | US
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Telephone | 281-486-5043
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Fax | 281-282-9885
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Provider Business Mailing Address
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Address Line | 19052 GULF FWY
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City | FRIENDSWOOD
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State | TX
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Zip | 77546-2703
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Country | US
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Telephone | 281-486-5043
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Fax | 281-282-9885
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | CARLEY MILLER
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Credential |
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Telephone | 281-535-8876
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | TX3270TG
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License Number State | TX
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