Provider Demographics
NPI:1184646796
Name:GLOYD, ROOSEVELT III (OD)
Entity Type:Individual
Prefix:DR
First Name:ROOSEVELT
Middle Name:
Last Name:GLOYD
Suffix:III
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5419 FM 1960 RD W STE C
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77069-4305
Mailing Address - Country:US
Mailing Address - Phone:281-894-2020
Mailing Address - Fax:281-537-7617
Practice Address - Street 1:5419 FM 1960 RD W STE C
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77069-4305
Practice Address - Country:US
Practice Address - Phone:281-894-2020
Practice Address - Fax:281-537-7617
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6821TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX183581101Medicaid
TX183581102Medicaid
V08948Medicare UPIN
TX183581102Medicaid
TX8G5049Medicare ID - Type Unspecified