MEDICARE: SOPER BROTHERS, INC.

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	332B00000X	Durable Medical Equipment & Medical Supplies	81-160-05	TX
2	156FC0800X	Contact Lens Technician/Technologist	DR3105	TX
3	156FC0801X	Contact Lens Fitter	DR3105	TX
4	156FX1700X	Ocularist	81-160-05

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	DR3105	OTHER	TX	TWC
2	38074	OTHER	TX	CIDC
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1891883690
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOPER BROTHERS, INC.

Provider Business Mailing Address
First Line	:	1213 HERMANN DR STE 320
Second Line	:	PARK PLAZA PROFESSIONAL BUILDING
City	:	HOUSTON
State	:	TX
Zip	:	77004-7000
Country	:	US
Telephone Number	:	713-521-1263
Fax Number	:	713-521-1264

Provider Business Practice Location Address
First Line	:	1213 HERMANN DR STE 320
Second Line	:	PARK PLAZA PROFESSIONAL BUILDING
City	:	HOUSTON
State	:	TX
Zip	:	77004-7000
Country	:	US
Telephone Number	:	713-521-1263
Fax Number	:	713-521-1264

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. MARCUS P. SOPER
Credential	:	B.C.O, F.C.L.S.A.
Telephone Number	:	713-521-1263

Provider Enumeration Date	:	10/10/2006
Last Update Date	:	10/02/2008

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Directions to “SOPER BROTHERS, INC. ” Practice Location

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