MEDICARE: EIVA EYE CARE PLLC

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	8865TG	OTHER	TX	VISION INSURANCES
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1841814985
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EIVA EYE CARE PLLC

Provider Business Mailing Address
First Line	:	1403 LEHMAN ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77018-1213
Country	:	US
Telephone Number	:	832-869-0691
Fax Number	:

Provider Business Practice Location Address
First Line	:	4078 WESTHEIMER RD STE 1
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77027-5008
Country	:	US
Telephone Number	:	832-778-8605
Fax Number	:

Authorized Official
Title or Position	:	OPTOMETRIST
Name	:	DR. NEDA ESMAEILI
Credential	:	OD
Telephone Number	:	832-860-0691

Provider Enumeration Date	:	06/04/2020
Last Update Date	:	06/04/2020

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