Provider Demographics
NPI:1205288057
Name:FANDRY, ELLEN (OD)
Entity type:Individual
Prefix:DR
First Name:ELLEN
Middle Name:
Last Name:FANDRY
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 1:11914 ORCHARD MOUNTAIN DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77059-5518
Mailing Address - Country:US
Mailing Address - Phone:281-794-0657
Mailing Address - Fax:
Practice Address - Street 1:402 SAWDUST RD
Practice Address - Street 2:
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77380-2243
Practice Address - Country:US
Practice Address - Phone:281-363-2020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-05
Last Update Date:2016-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8948T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist