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General NPI Number Information
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NPI Number | 1477640076
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Entity Type | Organization
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Legal Business Name | PLAZA OPTICAL
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Dates
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Enumeration Date | 10/06/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 22999 HWY 59 NORTH SUITE 124
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City | KINGWOOD
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State | TX
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Zip | 77339-4412
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Country | US
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Telephone | 281-348-3385
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Fax | 281-348-3386
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Provider Business Mailing Address
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Address Line | 22999 HWY 59 NORTH SUITE 124
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City | KINGWOOD
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State | TX
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Zip | 77339-4412
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Country | US
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Telephone | 281-348-3385
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Fax | 281-348-3386
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Authorized Official
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Title or Position | OPTHOLMOGIST
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Name | DR. CHARLES K CLARK
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Credential | MD
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Telephone | 281-348-3385
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number |
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License Number State |
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