MEDICARE: DR. IDIL OVUTMEN OD

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	9473	TX

General Provider Information

NPI Number	:	1992275077
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. IDIL OVUTMEN OD

Provider Business Mailing Address
First Line	:	5615 RIVERSTONE CROSSING DR
Second Line	:
City	:	SUGAR LAND
State	:	TX
Zip	:	77479-4869
Country	:	US
Telephone Number	:	832-344-7792
Fax Number	:

Provider Business Practice Location Address
First Line	:	1937 TEXAS AVE S
Second Line	:
City	:	COLLEGE STATION
State	:	TX
Zip	:	77840-3913
Country	:	US
Telephone Number	:	979-213-5104
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/30/2018
Last Update Date	:	11/30/2018

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