Provider Demographics
NPI:1942243126
Name:ROSANNA MAN NAR PUN OD PC
Entity Type:Organization
Organization Name:ROSANNA MAN NAR PUN OD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:ROSANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:PUN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:713-271-6898
Mailing Address - Street 1:9889 BELLAIRE BLVD STE 313
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77036-3468
Mailing Address - Country:US
Mailing Address - Phone:713-271-6898
Mailing Address - Fax:
Practice Address - Street 1:9889 BELLAIRE BLVD STE 313
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77036-3468
Practice Address - Country:US
Practice Address - Phone:713-271-6898
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-14
Last Update Date:2012-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5787152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX149833901Medicaid
TX8AJ003OtherBLUE CROSS BLUE SHIELD
TX00Y402OtherMEDICARE PTAN
TX919643OtherBLOCK VISION
TX149833901Medicaid