| |
401 W Fairmont Pkwy, Suite A, La Porte, TX 77571-6307 | |
(281) 471-6546 | |
(281) 471-3411 |
Full Name | |
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Type | Facility |
Speciality | Eyewear Supplier |
Location | 401 W Fairmont Pkwy, La Porte, Texas |
Accepts Medicare Assignments | Medicare enrolled and accepts medicare insurance. Providers at this facility may prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1336319813 | NPI | - | NPPES |
112415802 | Medicaid | TX |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
152W00000X | Optometrist | 3011TG (Texas) | Secondary |
332H00000X | Eyewear Supplier | 3011TG (Texas) | Primary |
Provider Name | Deborah S Bernay |
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Provider Type | Practitioner - Optometry |
Provider Identifiers | NPI Number: 1992708606 PECOS PAC ID: 8325197635 Enrollment ID: I20090515000421 |
Provider Name | Meagan Nicole Legrand |
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Provider Type | Practitioner - Optometry |
Provider Identifiers | NPI Number: 1003339755 PECOS PAC ID: 1254602030 Enrollment ID: I20170814001002 |
Provider Name | Arslan Tajammul |
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Provider Type | Practitioner - Optometry |
Provider Identifiers | NPI Number: 1962824045 PECOS PAC ID: 8527455278 Enrollment ID: I20220427000739 |
Mailing Address | Practice Location Address |
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401 W Fairmont Pkwy, Suite A, La Porte, TX 77571-6307 Ph: (281) 471-6546 | 401 W Fairmont Pkwy, Suite A, La Porte, TX 77571-6307 Ph: (281) 471-6546 |