MEDICARE: DR. ANITA NAZAR ALI O.D.

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	8163T	TX
2	152WC0802X	Corneal and Contact Management Optometrist	8163T	TX
3	152WP0200X	Pediatric Optometrist	8163T	TX
4	152WX0102X	Occupational Vision Optometrist	8163T	TX

General Provider Information

NPI Number	:	1376984583
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANITA NAZAR ALI O.D.

Provider Business Mailing Address
First Line	:	12343 MAIN ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77035-6205
Country	:	US
Telephone Number	:	713-597-2020
Fax Number	:

Provider Business Practice Location Address
First Line	:	12343 MAIN ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77035-6205
Country	:	US
Telephone Number	:	713-597-2020
Fax Number	:

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

Provider Enumeration Date	:	07/16/2013
Last Update Date	:	05/09/2016

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