Provider Demographics
NPI:1134198518
Name:NORTHLINE TSO PC
Entity type:Organization
Organization Name:NORTHLINE TSO PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:HR DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:FORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-453-2972
Mailing Address - Street 1:1250 UVALDE RD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77015-3708
Mailing Address - Country:US
Mailing Address - Phone:713-453-2972
Mailing Address - Fax:713-450-3609
Practice Address - Street 1:4400 NORTH FWY
Practice Address - Street 2:SUITE B300
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77022-3604
Practice Address - Country:US
Practice Address - Phone:713-697-2081
Practice Address - Fax:713-697-4339
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-16
Last Update Date:2011-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1551392-01Medicaid
TX1551392-01Medicaid
TX1255320001Medicare NSC