Provider Demographics
NPI:1982180410
Name:CHOUA, CONNIE (OD)
Entity Type:Individual
Prefix:
First Name:CONNIE
Middle Name:
Last Name:CHOUA
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12707 BOHEME DR APT 1310
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77024-5538
Mailing Address - Country:US
Mailing Address - Phone:469-952-8936
Mailing Address - Fax:
Practice Address - Street 1:19511 INTERSTATE 45 N
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77388-6015
Practice Address - Country:US
Practice Address - Phone:281-288-4447
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-18
Last Update Date:2018-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9420152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist