Provider Demographics
NPI:1427604933
Name:HOUSTON, ANNIE WILLIAMS (OD)
Entity type:Individual
Prefix:
First Name:ANNIE
Middle Name:WILLIAMS
Last Name:HOUSTON
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:ANNIE
Other - Middle Name:
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 12
Mailing Address - Street 2:
Mailing Address - City:BLUE RIDGE
Mailing Address - State:TX
Mailing Address - Zip Code:75424-0012
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3620 W 1ST ST STE 60
Practice Address - Street 2:
Practice Address - City:PROSPER
Practice Address - State:TX
Practice Address - Zip Code:75078-3493
Practice Address - Country:US
Practice Address - Phone:469-715-0775
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-12
Last Update Date:2024-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9839T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist