Provider Demographics
NPI:1881661478
Name:HOUTKIN, SAMUEL (OD)
Entity Type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:
Last Name:HOUTKIN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1311 WELLBORN RD STE A-300
Mailing Address - Street 2:
Mailing Address - City:COLLEGE STATION
Mailing Address - State:TX
Mailing Address - Zip Code:77840-4755
Mailing Address - Country:US
Mailing Address - Phone:979-764-0010
Mailing Address - Fax:979-764-7715
Practice Address - Street 1:1311 WELLBORN RD STE A-300
Practice Address - Street 2:
Practice Address - City:COLLEGE STATION
Practice Address - State:TX
Practice Address - Zip Code:77840-4755
Practice Address - Country:US
Practice Address - Phone:979-764-0010
Practice Address - Fax:979-764-7715
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-02
Last Update Date:2019-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2238T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX044493701Medicaid
TX410041586OtherRAILROAD MEDICARE
TX410041586OtherRAILROAD MEDICARE
TX044493701Medicaid