MEDICARE: ROYAL EYE CENTER, LLC

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

General Provider Information

NPI Number	:	1710445812
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROYAL EYE CENTER, LLC

Provider Business Mailing Address
First Line	:	5219 TRANQUIL TRCE
Second Line	:
City	:	ALVIN
State	:	TX
Zip	:	77511-9425
Country	:	US
Telephone Number	:	623-523-4049
Fax Number	:

Provider Business Practice Location Address
First Line	:	16929 EL CAMINO REAL
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77058-2614
Country	:	US
Telephone Number	:	623-523-4049
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	ZELMIRA MARIA FARMER
Credential	:	OD
Telephone Number	:	623-523-4049

Provider Enumeration Date	:	03/07/2019
Last Update Date	:	03/07/2019

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