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NPI Code Detail

MEDICARE: DR. RITA MAE MEDRANO O.D.

MEDICARE: DR. RITA MAE MEDRANO O.D.
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
1152W00000XOptometrist5427TTX

General Provider Information

NPI Number : 1053489161
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. RITA MAE MEDRANO O.D.
Provider Business Mailing Address
First Line : 9110 LAKES AT 610 DR
Second Line :
City : HOUSTON
State : TX
Zip : 77054-2403
Country : US
Telephone Number : 281-899-8265
Fax Number : 713-645-3030
Provider Business Practice Location Address
First Line : 4501 GROVEWAY DR
Second Line :
City : HOUSTON
State : TX
Zip : 77087-1122
Country : US
Telephone Number : 713-645-2020
Fax Number : 713-645-3030
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/30/2006
Last Update Date : 07/08/2007

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