Provider Demographics
NPI:1306016142
Name:HARVEY W STURDEVANTJR
Entity Type:Organization
Organization Name:HARVEY W STURDEVANTJR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HARVEY
Authorized Official - Middle Name:WILLARD
Authorized Official - Last Name:STURDEVANT
Authorized Official - Suffix:JR
Authorized Official - Credentials:OPTOMETRIST
Authorized Official - Phone:713-461-9927
Mailing Address - Street 1:2002 GESSNER DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77080-6323
Mailing Address - Country:US
Mailing Address - Phone:713-461-9927
Mailing Address - Fax:713-490-2165
Practice Address - Street 1:2002 GESSNER DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77080-6323
Practice Address - Country:US
Practice Address - Phone:713-461-9927
Practice Address - Fax:713-490-2165
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-07
Last Update Date:2010-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX02298TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0645440001Medicare NSC