MEDICARE: NGAN, INC

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	6433TG	TX
2	207W00000X	Ophthalmology Physician	G3557	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	G3557	OTHER	TX	MEDICAL LICENSE

General Provider Information

NPI Number	:	1275833907
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NGAN, INC

Provider Business Mailing Address
First Line	:	6737 STELLA LINK RD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77005-4342
Country	:	US
Telephone Number	:	713-432-1137
Fax Number	:	713-660-9909

Provider Business Practice Location Address
First Line	:	6737 STELLA LINK RD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77005-4342
Country	:	US
Telephone Number	:	713-432-1137
Fax Number	:	713-660-9909

Authorized Official
Title or Position	:	MD
Name	:	JOHN M LIM
Credential	:	MD
Telephone Number	:	713-432-1137

Provider Enumeration Date	:	10/28/2010
Last Update Date	:	10/28/2010

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Directions to “NGAN, INC ” Practice Location

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