Provider Demographics
NPI:1497129936
Name:OCCTOX
Entity Type:Organization
Organization Name:OCCTOX
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:M
Authorized Official - Last Name:DIETER
Authorized Official - Suffix:III
Authorized Official - Credentials:DC, NP-C
Authorized Official - Phone:281-525-6104
Mailing Address - Street 1:PO BOX 58388
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:TX
Mailing Address - Zip Code:77598-8388
Mailing Address - Country:US
Mailing Address - Phone:281-525-6104
Mailing Address - Fax:
Practice Address - Street 1:100 NASA PARKWAY
Practice Address - Street 2:STE 410
Practice Address - City:WEBSTER
Practice Address - State:TX
Practice Address - Zip Code:77598-5345
Practice Address - Country:US
Practice Address - Phone:281-525-6104
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-20
Last Update Date:2015-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory