MEDICARE: JODIE HOUNG 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
1	152W00000X	Optometrist	11264	TX

General Provider Information

NPI Number	:	1255159331
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JODIE HOUNG OD

Provider Business Mailing Address
First Line	:	29600 RONALD W REAGAN BLVD APT 6307
Second Line	:
City	:	GEORGETOWN
State	:	TX
Zip	:	78633-2513
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	590 MEDICAL CENTER ROAD
Second Line	:
City	:	FORT CAVAZOS
State	:	TX
Zip	:	76544-4906
Country	:	US
Telephone Number	:	254-288-8000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/28/2024
Last Update Date	:	12/30/2024

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