MEDICARE: NORTHWEST EYE ASSOCIATES

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
1	152W00000X	Optometrist
2	207W00000X	Ophthalmology Physician	H7593	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1154322022
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTHWEST EYE ASSOCIATES

Provider Business Mailing Address
First Line	:	1740 W 27TH ST
Second Line	:	SUITE 180
City	:	HOUSTON
State	:	TX
Zip	:	77008-1440
Country	:	US
Telephone Number	:	713-864-8652
Fax Number	:	713-864-2865

Provider Business Practice Location Address
First Line	:	1740 W 27TH ST
Second Line	:	SUITE 180
City	:	HOUSTON
State	:	TX
Zip	:	77008-1440
Country	:	US
Telephone Number	:	713-864-8652
Fax Number	:	713-864-2865

Authorized Official
Title or Position	:	ADMIN
Name	:	DIANA L RODRIGUEZ
Credential	:
Telephone Number	:	713-864-8652

Provider Enumeration Date	:	08/02/2005
Last Update Date	:	07/13/2023

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Directions to “NORTHWEST EYE ASSOCIATES ” Practice Location

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