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General NPI Number Information
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NPI Number | 1487813101
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Entity Type | Organization
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Legal Business Name | HOME EYE DOC INC
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Dates
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Enumeration Date | 06/06/2008
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Last Update Date | 07/25/2013
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Provider Practice Location Address
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Address Line | 11302 SILVER BAY CT
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City | PEARLAND
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State | TX
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Zip | 77584-8404
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Country | US
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Telephone | 281-380-6756
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Fax | 866-789-0768
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Provider Business Mailing Address
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Address Line | 11302 SILVER BAY CT
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City | PEARLAND
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State | TX
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Zip | 77584-8404
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Country | US
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Telephone | 281-380-6756
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Fax | 866-789-0768
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. IVAN JOSEPH SRUT
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Credential | O.D.
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Telephone | 281-380-6756
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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 | 6238TG
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 5342TG
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License Number State | TX
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