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General NPI Number Information
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NPI Number | 1437331477
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Entity Type | Organization
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Legal Business Name | M & M OPTICAL INC
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Dates
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Enumeration Date | 12/01/2007
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Last Update Date | 05/01/2013
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Provider Practice Location Address
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Address Line | 2409 FALCON PASS SUITE 180
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City | HOUSTON
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State | TX
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Zip | 77062-6238
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Country | US
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Telephone | 281-461-3937
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Fax | 281-461-6084
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Provider Business Mailing Address
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Address Line | 2409 FALCON PASS SUITE 180
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City | HOUSTON
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State | TX
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Zip | 77062-6238
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Country | US
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Telephone | 281-461-3937
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Fax | 281-461-6084
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Authorized Official
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Title or Position | DR/OPTOMETRIST
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Name | DR. LISA MARIE MAXWELL-MALIK
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Credential | O.D.
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Telephone | 281-461-3937
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152WC0802X
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Taxonomy Name | Corneal and Contact Management Optometrist
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License Number | 4123TG
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 152WP0200X
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Taxonomy Name | Pediatric Optometrist
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License Number | 4123TG
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 152WS0006X
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Taxonomy Name | Sports Vision Optometrist
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License Number | 4123TG
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License Number State | TX
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Taxonomy #4
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Taxonomy Code | 152WV0400X
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Taxonomy Name | Vision Therapy Optometrist
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License Number | 4123TG
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License Number State | TX
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Taxonomy #5
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 4123TG
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License Number State | TX
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