Provider Demographics
NPI:1437391059
Name:KATY FRY ROAD TSO
Entity Type:Organization
Organization Name:KATY FRY ROAD TSO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:READE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:832-242-2020
Mailing Address - Street 1:1245 N FRY RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77449-3430
Mailing Address - Country:US
Mailing Address - Phone:832-242-2020
Mailing Address - Fax:281-779-8630
Practice Address - Street 1:1245 N FRY RD
Practice Address - Street 2:SUITE A
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77449-3430
Practice Address - Country:US
Practice Address - Phone:832-242-2020
Practice Address - Fax:281-779-8630
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-27
Last Update Date:2009-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX03384152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX03384OtherTEXAS OPTOMETRY LICENSE