MEDICARE: MEMORIAL EYE, PA

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	156FX1800X	Optician
2	152W00000X	Optometrist

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1164498770
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEMORIAL EYE, PA

Provider Business Mailing Address
First Line	:	15080 MEMORIAL DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77079-4302
Country	:	US
Telephone Number	:	281-531-0300
Fax Number	:	281-531-0349

Provider Business Practice Location Address
First Line	:	15080 MEMORIAL DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77079-4302
Country	:	US
Telephone Number	:	281-531-0300
Fax Number	:	281-531-0349

Authorized Official
Title or Position	:	OPTOMETRIST
Name	:	DR. AMELIAL J. HOLBROOK
Credential	:	OD
Telephone Number	:	281-556-5353

Provider Enumeration Date	:	02/23/2006
Last Update Date	:	09/25/2012

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Directions to “MEMORIAL EYE, PA ” Practice Location

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