=====================================================
General NPI Number Information
=====================================================
NPI Number | 1952429201
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | R C OPTICAL
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/26/2007
-----------------------------------------------------
Last Update Date | 07/14/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1740 W 27TH ST SUITE 180
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77008-1440
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-862-8353
-----------------------------------------------------
Fax | 713-864-2865
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1740 W 27TH ST SUITE 180
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77008-1440
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-862-8353
-----------------------------------------------------
Fax | 713-864-2865
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. DORA E CANTU
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 713-864-8652
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332H00000X
-----------------------------------------------------
Taxonomy Name | Eyewear Supplier
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------