Provider Demographics
NPI:1912053034
Name:WISHNOW, IRVING CHARLES (OD)
Entity Type:Individual
Prefix:DR
First Name:IRVING
Middle Name:CHARLES
Last Name:WISHNOW
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5649 BEECHNUT ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77096-1021
Mailing Address - Country:US
Mailing Address - Phone:713-771-1206
Mailing Address - Fax:713-771-4747
Practice Address - Street 1:5649 BEECHNUT ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77096-1021
Practice Address - Country:US
Practice Address - Phone:713-771-1206
Practice Address - Fax:713-771-4747
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1640152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX74-1532044OtherTAX ID
TXE27MMedicare ID - Type UnspecifiedPROVIDER #
TX74-1532044OtherTAX ID