MEDICARE: KINDRED EYECARE, P.C.

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	6560TG	TX

General Provider Information

NPI Number	:	1871828145
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KINDRED EYECARE, P.C.

Provider Business Mailing Address
First Line	:	3040 COLLEGE PARK DR
Second Line	:
City	:	THE WOODLANDS
State	:	TX
Zip	:	77384-8002
Country	:	US
Telephone Number	:	936-257-1725
Fax Number	:	936-271-1726

Provider Business Practice Location Address
First Line	:	8219 SCORESBY MANOR CT
Second Line	:
City	:	SPRING
State	:	TX
Zip	:	77379-5318
Country	:	US
Telephone Number	:	281-257-6116
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	VICKY PHAM
Credential	:
Telephone Number	:	936-257-1725

Provider Enumeration Date	:	10/05/2009
Last Update Date	:	10/05/2009

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