Provider Demographics
NPI:1346326113
Name:AMBROSE MOBILE HEALTH CARE ASSOCIATION
Entity Type:Organization
Organization Name:AMBROSE MOBILE HEALTH CARE ASSOCIATION
Other - Org Name:MEDI OPTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FIAZ
Authorized Official - Middle Name:
Authorized Official - Last Name:ZAMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-441-3311
Mailing Address - Street 1:PO BOX 270926
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77277-0926
Mailing Address - Country:US
Mailing Address - Phone:281-441-3311
Mailing Address - Fax:281-441-3313
Practice Address - Street 1:3663 N SAM HOUSTON PKWY E
Practice Address - Street 2:STE 625
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77032-3600
Practice Address - Country:US
Practice Address - Phone:281-441-3311
Practice Address - Fax:281-441-3313
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-27
Last Update Date:2015-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1100XEye and Vision Services ProvidersTechnician/TechnologistOphthalmicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1125833-04Medicaid
TX0775160001Medicare NSC
00898YMedicare PIN
TXCN9055Medicare ID - Type UnspecifiedRAILROAD MEDICARE
TXCN9055Medicare PIN
TX1125833-04Medicaid