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NPI Code Detail

MEDICARE: KINDRED EYECARE, PC

MEDICARE: KINDRED EYECARE, PC
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
1152W00000XOptometristTX

General Provider Information

NPI Number : 1780977223
Entity Type Code : Organization
Provider Name (Legal Business Name) : KINDRED EYECARE, PC
Provider Business Mailing Address
First Line : 3040 COLLEGE PARK DR
Second Line :
City : THE WOODLANDS
State : TX
Zip : 77384-8002
Country : US
Telephone Number : 936-271-1725
Fax Number : 936-271-1726
Provider Business Practice Location Address
First Line : 3040 COLLEGE PARK DR
Second Line :
City : THE WOODLANDS
State : TX
Zip : 77384-8002
Country : US
Telephone Number : 936-271-1725
Fax Number : 936-271-1726
Authorized Official
Title or Position : PRESIDENT
Name : VICKY PHAM
Credential : OD
Telephone Number : 936-271-1725
Provider Enumeration Date : 05/17/2011
Last Update Date : 05/17/2011

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