Provider Demographics
NPI:1033481866
Name:EVERETTT L HYMAN ODPC
Entity Type:Organization
Organization Name:EVERETTT L HYMAN ODPC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EVERETT
Authorized Official - Middle Name:LLOYD
Authorized Official - Last Name:HYMAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:281-493-4455
Mailing Address - Street 1:14441 MEMORIAL DR
Mailing Address - Street 2:SUITE 7
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77079-6744
Mailing Address - Country:US
Mailing Address - Phone:281-493-4455
Mailing Address - Fax:
Practice Address - Street 1:14441 MEMORIAL DR
Practice Address - Street 2:SUITE 7
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77079-6744
Practice Address - Country:US
Practice Address - Phone:281-493-4455
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EVERETT L HYMAN ODPC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-02-09
Last Update Date:2012-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2237TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX019498701Medicaid
TX13987Medicare UPIN
TX00E78JMedicare PIN