Provider Demographics
NPI:1306925573
Name:MARCHA, KHALIL N (OD)
Entity type:Individual
Prefix:DR
First Name:KHALIL
Middle Name:N
Last Name:MARCHA
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 1:12122 GREENSPOINT DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77060-2002
Mailing Address - Country:US
Mailing Address - Phone:281-875-5439
Mailing Address - Fax:281-875-2266
Practice Address - Street 1:12122 GREENSPOINT DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77060-2002
Practice Address - Country:US
Practice Address - Phone:281-875-5439
Practice Address - Fax:281-875-2266
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2009-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2085T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX760025191OtherTAX IDENTIFICATION #
TX0935025-02Medicaid
TX760025191OtherTAX IDENTIFICATION #
TXT14591Medicare UPIN
TX8B9962Medicare ID - Type Unspecified