Provider Demographics
NPI:1588814818
Name:JEFFREY M. PENN O.D. PA
Entity Type:Organization
Organization Name:JEFFREY M. PENN O.D. PA
Other - Org Name:PENN EYECARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:M
Authorized Official - Last Name:PENN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:281-894-0011
Mailing Address - Street 1:17395 TOMBALL PKWY
Mailing Address - Street 2:3I-2
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77064-1179
Mailing Address - Country:US
Mailing Address - Phone:281-894-0011
Mailing Address - Fax:281-894-7799
Practice Address - Street 1:17395 TOMBALL PKWY
Practice Address - Street 2:3I-2
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77064-1179
Practice Address - Country:US
Practice Address - Phone:281-894-0011
Practice Address - Fax:281-894-7799
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-23
Last Update Date:2009-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2867TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0A3042Medicare PIN