Provider Demographics
NPI:1548236151
Name:MEMORIAL EYE, PA
Entity Type:Organization
Organization Name:MEMORIAL EYE, PA
Other - Org Name:MEMORIAL EYE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/OD
Authorized Official - Prefix:DR
Authorized Official - First Name:AMELIA
Authorized Official - Middle Name:J
Authorized Official - Last Name:HOLBROOK
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:281-556-5353
Mailing Address - Street 1:9620 WESTHEIMER RD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77063-3205
Mailing Address - Country:US
Mailing Address - Phone:713-975-9393
Mailing Address - Fax:713-975-1919
Practice Address - Street 1:9620 WESTHEIMER RD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77063-3205
Practice Address - Country:US
Practice Address - Phone:713-975-9393
Practice Address - Fax:713-975-1919
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-23
Last Update Date:2012-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0193799-01Medicaid
TX1127550004Medicare NSC
TX0193799-01Medicaid