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General NPI Number Information
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NPI Number | 1265139885
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Entity Type | Organization
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Legal Business Name | MITA VALA OD PLLC
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Dates
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Enumeration Date | 02/14/2023
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Last Update Date | 07/08/2023
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Provider Practice Location Address
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Address Line | 5135 W ALABAMA ST STE 5410
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City | HOUSTON
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State | TX
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Zip | 77056-5814
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Country | US
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Telephone | 832-279-2470
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1304
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City | BELLAIRE
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State | TX
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Zip | 77402-1304
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MITA VALA
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Credential | OD
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Telephone | 832-279-2470
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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 |
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License Number State |
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