Provider Demographics
NPI:1891883690
Name:SOPER BROTHERS, INC.
Entity Type:Organization
Organization Name:SOPER BROTHERS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MARCUS
Authorized Official - Middle Name:P
Authorized Official - Last Name:SOPER
Authorized Official - Suffix:
Authorized Official - Credentials:BCO, FCLSA
Authorized Official - Phone:713-521-1263
Mailing Address - Street 1:1213 HERMANN DR STE 320
Mailing Address - Street 2:PARK PLAZA PROFESSIONAL BUILDING
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77004-7000
Mailing Address - Country:US
Mailing Address - Phone:713-521-1263
Mailing Address - Fax:713-521-1264
Practice Address - Street 1:1213 HERMANN DR STE 320
Practice Address - Street 2:PARK PLAZA PROFESSIONAL BUILDING
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77004-7000
Practice Address - Country:US
Practice Address - Phone:713-521-1263
Practice Address - Fax:713-521-1264
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-10
Last Update Date:2008-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDR3105156FC0800X, 156FC0801X
81-160-05156FX1700X
TX81-160-05332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1700XEye and Vision Services ProvidersTechnician/TechnologistOcularistGroup - Single Specialty
No156FC0800XEye and Vision Services ProvidersTechnician/TechnologistContact LensGroup - Single Specialty
No156FC0801XEye and Vision Services ProvidersTechnician/TechnologistContact Lens FitterGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXDR3105OtherTWC
TX38074OtherCIDC
TX086142901Medicaid
TX38074OtherCIDC