MEDICARE: EYEDEAL EYECARE & EYEWEAR

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	6346T	TX

General Provider Information

NPI Number	:	1952341778
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EYEDEAL EYECARE & EYEWEAR

Provider Business Mailing Address
First Line	:	2519 UNIVERSITY BLVD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77005-3228
Country	:	US
Telephone Number	:	713-526-1718
Fax Number	:	713-526-3137

Provider Business Practice Location Address
First Line	:	2519 UNIVERSITY BLVD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77005-3228
Country	:	US
Telephone Number	:	713-526-1718
Fax Number	:	713-526-3137

Authorized Official
Title or Position	:	DIRECTOR
Name	:	DR. KIMBERLY H. THAM
Credential	:	O.D.
Telephone Number	:	713-526-1718

Provider Enumeration Date	:	06/08/2006
Last Update Date	:	07/29/2008

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