MEDICARE: OPA 1, LTD

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	332BC3200X	Customized Equipment (DME)
2	335E00000X	Prosthetic/Orthotic Supplier	101215	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	101215	OTHER	TX	STATE LICENSE

General Provider Information

NPI Number	:	1639252869
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OPA 1, LTD

Provider Business Mailing Address
First Line	:	7301 FANNIN ST STE B
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77030-4807
Country	:	US
Telephone Number	:	713-797-0011
Fax Number	:	713-797-0010

Provider Business Practice Location Address
First Line	:	850 FM 1960 RD W STE H
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77090-3413
Country	:	US
Telephone Number	:	281-444-3335
Fax Number	:	281-444-6366

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MR. KEVIN D HOLYFIELD
Credential	:
Telephone Number	:	713-797-0011

Provider Enumeration Date	:	10/23/2006
Last Update Date	:	07/16/2008

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