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General NPI Number Information
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NPI Number | 1487761292
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Entity Type | Organization
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Legal Business Name | PLAZA EYE CLINIC, PA
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Dates
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Enumeration Date | 08/25/2006
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Last Update Date | 04/20/2008
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Provider Practice Location Address
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Address Line | 5555 WEST LOOP S STE 150
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City | BELLAIRE
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State | TX
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Zip | 77401-2111
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Country | US
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Telephone | 713-666-4224
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Fax | 713-666-2203
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Provider Business Mailing Address
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Address Line | 5555 WEST LOOP S STE 150
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City | BELLAIRE
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State | TX
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Zip | 77401-2111
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Country | US
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Telephone | 713-666-4224
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Fax | 713-666-2203
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | VIVIAN RODRIGUEZ
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Credential | CMOM
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Telephone | 713-666-4224
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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 | D5949
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License Number State | TX
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