=====================================================
General NPI Number Information
=====================================================
NPI Number | 1801617238
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | IHLO ENTERPRISES, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/18/2024
-----------------------------------------------------
Last Update Date | 10/18/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 702 LOUISIANA ST
-----------------------------------------------------
City | CENTER
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75935-3672
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 936-598-8501
-----------------------------------------------------
Fax | 936-598-2311
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 1838
-----------------------------------------------------
City | CENTER
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75935-1838
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 936-598-8501
-----------------------------------------------------
Fax | 936-598-2311
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/PRESIDENT
-----------------------------------------------------
Name | HEATHER IHLO
-----------------------------------------------------
Credential | OD
-----------------------------------------------------
Telephone | 936-598-8501
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152WC0802X
-----------------------------------------------------
Taxonomy Name | Corneal and Contact Management Optometrist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------