Provider Demographics
NPI:1508051038
Name:CONNER OPTICAL SERVICE INC
Entity Type:Organization
Organization Name:CONNER OPTICAL SERVICE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES
Authorized Official - Prefix:MR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:E
Authorized Official - Last Name:CONNER
Authorized Official - Suffix:
Authorized Official - Credentials:CERTIFIED OPTICIAN
Authorized Official - Phone:713-664-9961
Mailing Address - Street 1:5400 BELLAIRE
Mailing Address - Street 2:#H
Mailing Address - City:BELLAIRE
Mailing Address - State:TX
Mailing Address - Zip Code:77401
Mailing Address - Country:US
Mailing Address - Phone:713-664-9961
Mailing Address - Fax:
Practice Address - Street 1:5400 BELLAIRE
Practice Address - Street 2:#H
Practice Address - City:BELLAIRE
Practice Address - State:TX
Practice Address - Zip Code:77401
Practice Address - Country:US
Practice Address - Phone:713-664-9961
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-07
Last Update Date:2007-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0732120001Medicare PIN