Provider Demographics
NPI:1316931793
Name:CAVALLARO, ANN-MARIE M R (OD)
Entity type:Individual
Prefix:
First Name:ANN-MARIE
Middle Name:M R
Last Name:CAVALLARO
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:ANN-MARIE
Other - Middle Name:M R
Other - Last Name:SERRANDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1616 CLEAR LAKE CITY BLVD
Mailing Address - Street 2:STE 103
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77062-8069
Mailing Address - Country:US
Mailing Address - Phone:281-286-4343
Mailing Address - Fax:281-286-4344
Practice Address - Street 1:1616 CLEAR LAKE CITY BLVD
Practice Address - Street 2:SUITE 103
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77062-8069
Practice Address - Country:US
Practice Address - Phone:281-286-4343
Practice Address - Fax:281-286-4344
Is Sole Proprietor?:No
Enumeration Date:2005-08-31
Last Update Date:2013-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5062TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX81225EMedicare PIN