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General NPI Number Information
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NPI Number | 1376775684
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Entity Type | Organization
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Legal Business Name | EYES OVER TEXAS EYE CARE, P.A.
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Dates
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Enumeration Date | 08/20/2009
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Last Update Date | 10/28/2010
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Provider Practice Location Address
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Address Line | 21318 PROVINCIAL BLVD
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City | KATY
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State | TX
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Zip | 77450-7580
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Country | US
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Telephone | 281-398-0747
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Fax | 281-398-9825
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Provider Business Mailing Address
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Address Line | 21318 PROVINCIAL BLVD
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City | KATY
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State | TX
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Zip | 77450-7580
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Country | US
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Telephone | 281-398-0747
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Fax | 281-398-9825
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Authorized Official
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Title or Position | PRESIDENT
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Name | RANDOLPH P WHITFORD
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Credential | M.D.
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Telephone | 281-398-0747
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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 | F4680
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License Number State | TX
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