=====================================================
General NPI Number Information
=====================================================
NPI Number | 1588865869
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CHRISTY OPTICAL INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/31/2007
-----------------------------------------------------
Last Update Date | 03/03/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6624 FANNIN ST SUITE 130
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77030-2741
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-790-1085
-----------------------------------------------------
Fax | 713-790-1087
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6624 FANNIN ST SUITE 130
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77030-2741
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-795-4862
-----------------------------------------------------
Fax | 713-795-4866
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | VICE PRESIDENT
-----------------------------------------------------
Name | MR. CHARLES A ORR
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 713-790-1085
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332H00000X
-----------------------------------------------------
Taxonomy Name | Eyewear Supplier
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------