MEDICARE: MACULA VITREOUS RETINA PHYSICIANS & SURGEONS PA

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	207WX0107X	Retina Specialist (Ophthalmology) Physician	M1566	TX

General Provider Information

NPI Number	:	1538526173
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MACULA VITREOUS RETINA PHYSICIANS & SURGEONS PA

Provider Business Mailing Address
First Line	:	6655 TRAVIS ST STE 560
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77030-1316
Country	:	US
Telephone Number	:	713-637-4408
Fax Number	:	346-226-3668

Provider Business Practice Location Address
First Line	:	6655 TRAVIS ST
Second Line	:	SUITE 560
City	:	HOUSTON
State	:	TX
Zip	:	77030-1312
Country	:	US
Telephone Number	:	713-637-4408
Fax Number	:	832-547-2221

Authorized Official
Title or Position	:	PRESIDENT
Name	:	PETROS EUTHYMIOU CARVOUNIS
Credential	:	MD
Telephone Number	:	713-637-4408

Provider Enumeration Date	:	01/27/2016
Last Update Date	:	12/03/2025

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