MEDICARE: NEW WAVE OPTICAL

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	5718TG	TX

General Provider Information

NPI Number	:	1962837237
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEW WAVE OPTICAL

Provider Business Mailing Address
First Line	:	22513 STATE HIGHWAY 249 STE 123
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77070-1541
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	22513 STATE HIGHWAY 249 STE 123
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77070-1541
Country	:	US
Telephone Number	:	281-704-2285
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ALICE CHOY
Credential	:	O.D.
Telephone Number	:	281-704-2285

Provider Enumeration Date	:	09/05/2013
Last Update Date	:	09/23/2013

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Directions to “NEW WAVE OPTICAL ” Practice Location

Language	Start Address	Practice Location

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