Provider Demographics
NPI:1851533236
Name:HOUSTON, SAMUEL KENNEY III (MD)
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:KENNEY
Last Name:HOUSTON
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:SAMUEL
Other - Middle Name:K STEVEN
Other - Last Name:HOUSTON
Other - Suffix:III
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:95 COLUMBIA ST
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-1101
Mailing Address - Country:US
Mailing Address - Phone:407-849-9621
Mailing Address - Fax:407-367-6346
Practice Address - Street 1:95 COLUMBIA ST
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-1101
Practice Address - Country:US
Practice Address - Phone:407-849-9621
Practice Address - Fax:407-420-4056
Is Sole Proprietor?:No
Enumeration Date:2009-03-31
Last Update Date:2023-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME123038207WX0107X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL015132500Medicaid
FL015132500Medicaid