=====================================================
General NPI Number Information
=====================================================
NPI Number | 1619904398
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARTIN J ARISCO MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/27/2006
-----------------------------------------------------
Last Update Date | 03/18/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1025 BIRDSONG DR STE A
-----------------------------------------------------
City | BAYTOWN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77521-3205
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-422-2020
-----------------------------------------------------
Fax | 281-422-4959
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4301 GARTH RD SUITE 100
-----------------------------------------------------
City | BAYTOWN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77521-3153
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-422-2020
-----------------------------------------------------
Fax | 281-422-4959
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207W00000X
-----------------------------------------------------
Taxonomy Name | Ophthalmology Physician
-----------------------------------------------------
License Number | D2343
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------