MEDICARE: DENNY C JOE OD

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	4823TG	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1629088703
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DENNY C JOE OD

Provider Business Mailing Address
First Line	:	24230 KUYKENDAHL RD., SUITE 260
Second Line	:
City	:	TOMBALL
State	:	TX
Zip	:	77375-5176
Country	:	US
Telephone Number	:	832-639-8910
Fax Number	:	832-639-8150

Provider Business Practice Location Address
First Line	:	4603 FM 1960 WEST ROAD
Second Line	:	SUITE C
City	:	HOUSTON
State	:	TX
Zip	:	77069
Country	:	US
Telephone Number	:	281-893-1233
Fax Number	:	281-893-1232

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

Provider Enumeration Date	:	08/09/2006
Last Update Date	:	04/19/2016

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