=====================================================
General NPI Number Information
=====================================================
NPI Number | 1629088703
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DENNY C JOE OD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/09/2006
-----------------------------------------------------
Last Update Date | 04/19/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4603 FM 1960 WEST ROAD SUITE C
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77069
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-893-1233
-----------------------------------------------------
Fax | 281-893-1232
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 24230 KUYKENDAHL RD., SUITE 260
-----------------------------------------------------
City | TOMBALL
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77375-5176
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 832-639-8910
-----------------------------------------------------
Fax | 832-639-8150
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 4823TG
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------