MEDICARE: MADELINE MARGARET FOSSITT

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	11700TG	TX

General Provider Information

NPI Number	:	1558295154
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MADELINE MARGARET FOSSITT

Provider Business Mailing Address
First Line	:	3007 SENECA FALLS LN
Second Line	:
City	:	KATY
State	:	TX
Zip	:	77494-4065
Country	:	US
Telephone Number	:	214-842-0027
Fax Number	:

Provider Business Practice Location Address
First Line	:	11168 FONDREN RD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77096-5506
Country	:	US
Telephone Number	:	832-325-0118
Fax Number	:

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

Provider Enumeration Date	:	06/09/2026
Last Update Date	:	06/09/2026

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