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General NPI Number Information
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NPI Number | 1770919920
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Entity Type | Organization
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Legal Business Name | MODERN EYEWEAR
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Dates
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Enumeration Date | 09/19/2013
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Last Update Date | 09/19/2013
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Provider Practice Location Address
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Address Line | 19732 SAUMS ROAD
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City | HOUSTON
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State | TX
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Zip | 77084
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Country | US
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Telephone | 281-398-5050
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Fax |
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Provider Business Mailing Address
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Address Line | 19732 SAUMS ROAD
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City | HOUSTON
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State | TX
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Zip | 77084
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Country | US
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Telephone | 281-398-5050
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Fax |
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Authorized Official
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Title or Position | CERTIFIED OPTICIAN
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Name | MR. KHALID MUHAMMAD
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Credential |
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Telephone | 281-398-5050
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 156FX1800X
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Taxonomy Name | Optician
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License Number | 005902
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License Number State | TX
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