Provider Demographics
NPI:1851350789
Name:CERVANTES KARIM, LILIANA (OD)
Entity Type:Individual
Prefix:DR
First Name:LILIANA
Middle Name:
Last Name:CERVANTES KARIM
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1802 WIRT RD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77055-2407
Mailing Address - Country:US
Mailing Address - Phone:713-290-9900
Mailing Address - Fax:713-290-9932
Practice Address - Street 1:1802 WIRT RD
Practice Address - Street 2:STE B
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77055-2407
Practice Address - Country:US
Practice Address - Phone:713-290-9900
Practice Address - Fax:713-290-9932
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-20
Last Update Date:2013-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6503TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX163498201Medicaid
TX163498201Medicaid
TX8B3207Medicare ID - Type Unspecified