Provider Demographics
NPI:1487784526
Name:HOUSTON OPTIC, PLLC
Entity type:Organization
Organization Name:HOUSTON OPTIC, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF INFORMATION OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:MERKLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-668-6828
Mailing Address - Street 1:2855 GRAMERCY ST STE 400
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77025-1756
Mailing Address - Country:US
Mailing Address - Phone:713-668-6828
Mailing Address - Fax:
Practice Address - Street 1:9230 KATY FWY STE 550
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77055
Practice Address - Country:US
Practice Address - Phone:713-467-9084
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-07
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX165108332H00000X, 156FX1800X, 332H00000X
332B00000X
TXF0436332H00000X
TX0523T332H00000X
TXG2587332H00000X
TX03629TG332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332H00000XSuppliersEyewear SupplierGroup - Single Specialty
Yes332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
No156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1558476788OtherGROUP NPI
6006810014OtherNSC
TX114542701Medicaid
TX093197404Medicaid
TX165108OtherAMER. BOARD OF OPTICIANRY
TXU63893Medicare UPIN
TXG74421Medicare UPIN
TX139414003Medicaid
TX8A6253Medicare PIN
TXT96235Medicare UPIN
TX87V801Medicare PIN
TX8D7053Medicare PIN
TX165108OtherAMER. BOARD OF OPTICIANRY
TX8A2093Medicare PIN
TX104405902Medicaid
TXB20947Medicare UPIN
TX114542701Medicaid