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General NPI Number Information
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NPI Number | 1982990925
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Entity Type | Organization
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Legal Business Name | HOUSTON RETINA CENTER
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Dates
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Enumeration Date | 06/28/2011
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Last Update Date | 06/28/2011
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Provider Practice Location Address
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Address Line | 6012 CHARLOTTE ST
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City | HOUSTON
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State | TX
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Zip | 77005-3120
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Country | US
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Telephone | 318-623-1883
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Fax |
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Provider Business Mailing Address
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Address Line | 6012 CHARLOTTE ST
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City | HOUSTON
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State | TX
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Zip | 77005-3120
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | ANDREW KOPEL
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Credential | M.D.
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Telephone | 318-623-1883
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | M3618
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License Number State | TX
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