MEDICARE: FIRST TEXAS OPTOMETRIC PC

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

General Provider Information

NPI Number	:	1235854746
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FIRST TEXAS OPTOMETRIC PC

Provider Business Mailing Address
First Line	:	3333 QUALITY DR
Second Line	:
City	:	RANCHO CORDOVA
State	:	CA
Zip	:	95670-7985
Country	:	US
Telephone Number	:	704-712-0564
Fax Number	:

Provider Business Practice Location Address
First Line	:	1329 W DAVIS ST
Second Line	:
City	:	CONROE
State	:	TX
Zip	:	77304-2309
Country	:	US
Telephone Number	:	936-441-3937
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	STEVE JUNG
Credential	:	OD
Telephone Number	:	541-338-4844

Provider Enumeration Date	:	10/06/2022
Last Update Date	:	09/29/2023

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Directions to “FIRST TEXAS OPTOMETRIC PC ” Practice Location

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