MEDICARE: DR. JOSHUA RYAN DEVERA 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	9016	TX

General Provider Information

NPI Number	:	1477904399
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOSHUA RYAN DEVERA O.D.

Provider Business Mailing Address
First Line	:	3457 CLEAR LAKE CITY BLVD # 500
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77059-2516
Country	:	US
Telephone Number	:	281-729-5070
Fax Number	:	832-304-5014

Provider Business Practice Location Address
First Line	:	3457 CLEAR LAKE CITY BLVD # 500
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77059-2516
Country	:	US
Telephone Number	:	281-729-5070
Fax Number	:	832-304-5014

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

Provider Enumeration Date	:	06/22/2016
Last Update Date	:	10/16/2020

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