Provider Demographics
NPI:1790158855
Name:PETKOVA - VAMVAKA, TIHOMIRA (OD, PHD)
Entity Type:Individual
Prefix:DR
First Name:TIHOMIRA
Middle Name:
Last Name:PETKOVA - VAMVAKA
Suffix:
Gender:F
Credentials:OD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4310 DUNLAVY ST
Mailing Address - Street 2:APT.350
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77006-5292
Mailing Address - Country:US
Mailing Address - Phone:832-202-4780
Mailing Address - Fax:
Practice Address - Street 1:4310 DUNLAVY ST
Practice Address - Street 2:APT.350
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77006-5292
Practice Address - Country:US
Practice Address - Phone:832-202-4780
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-10
Last Update Date:2017-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8626TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist