Provider Demographics
NPI:1881824571
Name:NORTHWEST EYE OPTICAL
Entity Type:Organization
Organization Name:NORTHWEST EYE OPTICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DORA
Authorized Official - Middle Name:E
Authorized Official - Last Name:CANTU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-862-8353
Mailing Address - Street 1:1740 W 27TH ST
Mailing Address - Street 2:SUITE 180
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77008-1440
Mailing Address - Country:US
Mailing Address - Phone:713-862-8353
Mailing Address - Fax:713-864-2865
Practice Address - Street 1:1740 W 27TH ST
Practice Address - Street 2:SUITE 180
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77008-1440
Practice Address - Country:US
Practice Address - Phone:713-862-8353
Practice Address - Fax:713-864-2865
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-16
Last Update Date:2009-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty