MEDICARE: HOUSTON OCUOPLASTIC 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	156FX1100X	Ophthalmic Technician/Technologist	L2839	TX

General Provider Information

NPI Number	:	1851659700
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOUSTON OCUOPLASTIC ASSOCIATES

Provider Business Mailing Address
First Line	:	1913 CANTERBURY ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77030-4103
Country	:	US
Telephone Number	:	832-868-3938
Fax Number	:

Provider Business Practice Location Address
First Line	:	1913 CANTERBURY ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77030-4103
Country	:	US
Telephone Number	:	832-868-3938
Fax Number	:

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MRS. WALAA MOUSSA
Credential	:
Telephone Number	:	832-868-3938

Provider Enumeration Date	:	04/29/2012
Last Update Date	:	04/29/2012

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