Provider Demographics
NPI:1891134367
Name:WILLOWBROOK EYE ASSOCIATES PLLC
Entity Type:Organization
Organization Name:WILLOWBROOK EYE ASSOCIATES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NAVEERA
Authorized Official - Middle Name:
Authorized Official - Last Name:FAROOQUE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:281-970-3840
Mailing Address - Street 1:1678 WILLOWBROOK MALL
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77070-6027
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1678 WILLOWBROOK MALL
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77070-6027
Practice Address - Country:US
Practice Address - Phone:281-970-3840
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-18
Last Update Date:2013-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7398152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty