MEDICARE: UNIVERSITY EYE ASSOCIATES

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
2	207W00000X	Ophthalmology Physician

General Provider Information

NPI Number	:	1689655672
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UNIVERSITY EYE ASSOCIATES

Provider Business Mailing Address
First Line	:	6400 FANNIN ST FL 18
Second Line	:	SUITE 1800
City	:	HOUSTON
State	:	TX
Zip	:	77030-1511
Country	:	US
Telephone Number	:	713-559-5200
Fax Number	:	713-559-5292

Provider Business Practice Location Address
First Line	:	6400 FANNIN ST FL 18
Second Line	:	SUITE 1800
City	:	HOUSTON
State	:	TX
Zip	:	77030-1511
Country	:	US
Telephone Number	:	713-559-5200
Fax Number	:	713-559-5292

Authorized Official
Title or Position	:	CFO
Name	:	MR. VON JOHNSON
Credential	:
Telephone Number	:	713-486-9435

Provider Enumeration Date	:	11/08/2005
Last Update Date	:	02/07/2022

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Directions to “UNIVERSITY EYE ASSOCIATES ” Practice Location

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