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NPI Code Detail

MEDICARE: DR. GILBERT HOUSTON OD

MEDICARE:  DR. GILBERT  HOUSTON  OD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1152W00000XOptometristOPC2664FL

General Provider Information

NPI Number : 1013901990
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. GILBERT HOUSTON OD
Provider Business Mailing Address
First Line : 150 PROFESSIONAL DR
Second Line : STE 300
City : PONTE VEDRA BEACH
State : FL
Zip : 32082-6216
Country : US
Telephone Number : 904-285-8448
Fax Number : 904-285-8448
Provider Business Practice Location Address
First Line : 150 PROFESSIONAL DR
Second Line : STE 300
City : PONTE VEDRA BEACH
State : FL
Zip : 32082-6216
Country : US
Telephone Number : 904-285-8448
Fax Number : 904-285-3410
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/07/2005
Last Update Date : 07/08/2007

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Directions to “ DR. GILBERT HOUSTON OD” Practice Location

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