MEDICARE: WILLOWBROOK EYE ASSOCIATES 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	7398	TX

General Provider Information

NPI Number	:	1891134367
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WILLOWBROOK EYE ASSOCIATES PLLC

Provider Business Mailing Address
First Line	:	1678 WILLOWBROOK MALL
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77070-6027
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1678 WILLOWBROOK MALL
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77070-6027
Country	:	US
Telephone Number	:	281-970-3840
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	NAVEERA FAROOQUE
Credential	:	OD
Telephone Number	:	281-970-3840

Provider Enumeration Date	:	06/18/2013
Last Update Date	:	06/18/2013

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