=====================================================
General NPI Number Information
=====================================================
NPI Number | 1649653478
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WINK EYE CARE & EYEWEAR PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/29/2015
-----------------------------------------------------
Last Update Date | 05/31/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1461 WIRT RD
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77055-4916
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 210-286-9475
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1461 WIRT RD
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77055-4916
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 832-317-6665
-----------------------------------------------------
Fax | 713-489-5615
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OD/OWNER
-----------------------------------------------------
Name | MS. ERICA ALFARO
-----------------------------------------------------
Credential | OD/OWNER
-----------------------------------------------------
Telephone | 832-317-6665
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------