Provider Demographics
NPI:1518572122
Name:MEMORIAL 2020 PLLC
Entity Type:Organization
Organization Name:MEMORIAL 2020 PLLC
Other - Org Name:PUPILA FAMILY EYECARE (MEMORIAL LOCATION)
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SUPRIYA
Authorized Official - Middle Name:
Authorized Official - Last Name:KRISHNAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:713-324-8889
Mailing Address - Street 1:12512 MEMORIAL DR STE A
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77024-6008
Mailing Address - Country:US
Mailing Address - Phone:713-324-8889
Mailing Address - Fax:713-324-8909
Practice Address - Street 1:12512 MEMORIAL DR STE A
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77024-6008
Practice Address - Country:US
Practice Address - Phone:713-324-8889
Practice Address - Fax:713-324-8909
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MEMORIAL 2020 PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-09-10
Last Update Date:2023-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Multi-Specialty