=====================================================
General NPI Number Information
=====================================================
NPI Number | 1427135060
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | M DELSARDO CORP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/01/2006
-----------------------------------------------------
Last Update Date | 06/23/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6100 WESTHEIMER RD STE 138
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77057-4535
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-785-2022
-----------------------------------------------------
Fax | 713-785-1975
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6100 WESTHEIMER RD STE 138
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77057-4535
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-785-2022
-----------------------------------------------------
Fax | 713-785-1975
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MICHAEL DEL SARDO
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 713-785-2022
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 5112TG
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------