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General NPI Number Information
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NPI Number | 1437391059
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Entity Type | Organization
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Legal Business Name | KATY FRY ROAD TSO
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Dates
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Enumeration Date | 03/27/2009
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Last Update Date | 03/27/2009
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Provider Practice Location Address
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Address Line | 1245 N FRY RD SUITE A
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City | KATY
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State | TX
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Zip | 77449-3430
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Country | US
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Telephone | 832-242-2020
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Fax | 281-779-8630
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Provider Business Mailing Address
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Address Line | 1245 N FRY RD SUITE A
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City | KATY
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State | TX
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Zip | 77449-3430
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Country | US
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Telephone | 832-242-2020
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Fax | 281-779-8630
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Authorized Official
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Title or Position | PRESIDENT
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Name | MICHAEL READE
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Credential | OD
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Telephone | 832-242-2020
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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 | 03384
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License Number State | TX
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