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NPI Code Detail

MEDICARE: KINGWOOD FAMILY VISION CENTER PLLC

MEDICARE: KINGWOOD FAMILY VISION CENTER PLLC
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
1152W00000XOptometrist

General Provider Information

NPI Number : 1316204282
Entity Type Code : Organization
Provider Name (Legal Business Name) : KINGWOOD FAMILY VISION CENTER PLLC
Provider Business Mailing Address
First Line : 25 N MAIN ST
Second Line :
City : KINGWOOD
State : TX
Zip : 77339-3710
Country : US
Telephone Number : 281-361-2020
Fax Number : 281-361-0702
Provider Business Practice Location Address
First Line : 25 N MAIN ST
Second Line :
City : KINGWOOD
State : TX
Zip : 77339-3710
Country : US
Telephone Number : 281-361-2020
Fax Number : 281-361-0702
Authorized Official
Title or Position : OPTOMETRIST
Name : MARK D. ANDERSON
Credential : OD
Telephone Number : 281-361-2020
Provider Enumeration Date : 04/17/2012
Last Update Date : 04/17/2012

Similar Medicare Providers

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Practice Phone: 281-361-2020
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1598948614 — RHONDA LYNN ANDERSON
Practice Location Address:
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KINGWOOD, TX
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1205240553 — BRITTNEY PROBST O.D.
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1104559830 — SAMMY-KUMAR HOGAN OD
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Directions to “KINGWOOD FAMILY VISION CENTER PLLC ” Practice Location

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