Provider Demographics
NPI:1629088703
Name:JOE, DENNY C (OD)
Entity Type:Individual
Prefix:
First Name:DENNY
Middle Name:C
Last Name:JOE
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:24230 KUYKENDAHL RD., SUITE 260
Mailing Address - Street 2:
Mailing Address - City:TOMBALL
Mailing Address - State:TX
Mailing Address - Zip Code:77375-5176
Mailing Address - Country:US
Mailing Address - Phone:832-639-8910
Mailing Address - Fax:832-639-8150
Practice Address - Street 1:4603 FM 1960 WEST ROAD
Practice Address - Street 2:SUITE C
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77069
Practice Address - Country:US
Practice Address - Phone:281-893-1233
Practice Address - Fax:281-893-1232
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2016-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4823TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX167523301Medicaid
TX8C2267Medicare ID - Type Unspecified
TX167523301Medicaid