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General NPI Number Information
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NPI Number | 1265991855
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Entity Type | Organization
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Legal Business Name | TEXAS RETINA CENTER, PLLC
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Dates
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Enumeration Date | 03/13/2019
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Last Update Date | 03/13/2019
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Provider Practice Location Address
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Address Line | 2929 WESLAYAN ST APT 1808
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City | HOUSTON
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State | TX
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Zip | 77027-2025
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Country | US
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Telephone | 713-725-8012
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Fax |
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Provider Business Mailing Address
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Address Line | 2929 WESLAYAN ST APT 1808
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City | HOUSTON
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State | TX
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Zip | 77027-2025
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Country | US
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Telephone | 713-501-2621
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | DR. SHAHEEN CYRUS KAVOUSSI
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Credential | MD
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Telephone | 713-725-8012
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QS0132X
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Taxonomy Name | Ophthalmologic Surgery Clinic/Center
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License Number |
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License Number State |
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