Provider Demographics
NPI:1427056787
Name:ELDRED, KIA (OD)
Entity type:Individual
Prefix:DR
First Name:KIA
Middle Name:
Last Name:ELDRED
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 1:505 J DAVIS ARMISTEAD BLDG
Mailing Address - Street 2:4901 CALHOUN
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77204-2020
Mailing Address - Country:US
Mailing Address - Phone:713-743-1921
Mailing Address - Fax:713-743-0963
Practice Address - Street 1:505 J DAVIS ARMISTEAD BLDG
Practice Address - Street 2:4901 CALHOUN
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77204-2020
Practice Address - Country:US
Practice Address - Phone:713-743-1921
Practice Address - Fax:713-743-0963
Is Sole Proprietor?:No
Enumeration Date:2005-07-11
Last Update Date:2010-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3777T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX037174201Medicaid
TX80461EMedicare ID - Type Unspecified
TX037174201Medicaid