MEDICARE: DR. JOHN PAUL TAVARES OD

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	6418TG	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1821063181
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN PAUL TAVARES OD

Provider Business Mailing Address
First Line	:	2470 GRAY FALLS DR STE 150
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77077-6525
Country	:	US
Telephone Number	:	281-556-5353
Fax Number	:

Provider Business Practice Location Address
First Line	:	2677 WILCREST DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77042-3211
Country	:	US
Telephone Number	:	713-977-1170
Fax Number	:	713-977-3327

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/21/2006
Last Update Date	:	09/25/2012

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