MEDICARE: DR. JIMMY V JOSEPH 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	6785TG	TX

General Provider Information

NPI Number	:	1396730107
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JIMMY V JOSEPH O.D.

Provider Business Mailing Address
First Line	:	6210 DUKE TRAIL LN
Second Line	:
City	:	SUGAR LAND
State	:	TX
Zip	:	77479-4465
Country	:	US
Telephone Number	:	215-479-9112
Fax Number	:	281-286-4344

Provider Business Practice Location Address
First Line	:	6026 HIGHWAY 6
Second Line	:
City	:	MISSOURI CITY
State	:	TX
Zip	:	77459-4163
Country	:	US
Telephone Number	:	281-499-2600
Fax Number	:	281-499-6556

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

Provider Enumeration Date	:	09/19/2005
Last Update Date	:	10/03/2013

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