MEDICARE: SMJ EYE GROUP 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

General Provider Information

NPI Number	:	1932773264
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SMJ EYE GROUP PLLC

Provider Business Mailing Address
First Line	:	PO BOX 79124
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77279-9124
Country	:	US
Telephone Number	:	281-300-1447
Fax Number	:

Provider Business Practice Location Address
First Line	:	9453 KATY FWY STE B
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77024-1503
Country	:	US
Telephone Number	:	346-395-5563
Fax Number	:

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	JITESH PATEL
Credential	:	OD
Telephone Number	:	281-300-1447

Provider Enumeration Date	:	05/20/2021
Last Update Date	:	12/16/2021

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