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NPI Code Detail

MEDICARE: EYEDENTITY, P.A.

MEDICARE: EYEDENTITY, P.A.
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
1152W00000XOptometrist6346TTX

General Provider Information

NPI Number : 1659663292
Entity Type Code : Organization
Provider Name (Legal Business Name) : EYEDENTITY, P.A.
Provider Business Mailing Address
First Line : 2519 UNIVERSITY BLVD
Second Line :
City : HOUSTON
State : TX
Zip : 77005-3228
Country : US
Telephone Number : 713-526-1718
Fax Number : 713-526-3137
Provider Business Practice Location Address
First Line : 3506 HIGHWAY 6 S
Second Line :
City : HOUSTON
State : TX
Zip : 77082-4204
Country : US
Telephone Number : 713-526-1718
Fax Number : 713-526-3137
Authorized Official
Title or Position : DIRECTOR
Name : DR. KIMBERLY THAM
Credential : O.D.
Telephone Number : 713-526-1718
Provider Enumeration Date : 05/13/2011
Last Update Date : 05/20/2011

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Directions to “EYEDENTITY, P.A. ” Practice Location

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