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General NPI Number Information
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NPI Number | 1619520152
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Entity Type | Organization
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Legal Business Name | TEXAS EYE HEROES
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Dates
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Enumeration Date | 07/23/2019
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Last Update Date | 12/18/2019
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Provider Practice Location Address
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Address Line | 132 SOUTHMORE AVE STE A
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City | PASADENA
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State | TX
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Zip | 77502-1018
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Country | US
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Telephone | 281-888-8073
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Fax | 832-917-1509
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Provider Business Mailing Address
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Address Line | 3206 E CEDAR HOLLOW DR
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City | PEARLAND
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State | TX
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Zip | 77584-8125
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | MAVIS DAO
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Credential | OD
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Telephone | 832-606-5761
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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 |
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License Number State |
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