Provider Demographics
NPI:1538526173
Name:MACULA VITREOUS RETINA PHYSICIANS & SURGEONS PA
Entity type:Organization
Organization Name:MACULA VITREOUS RETINA PHYSICIANS & SURGEONS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:PETROS
Authorized Official - Middle Name:E
Authorized Official - Last Name:CARVOUNIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-637-4408
Mailing Address - Street 1:6655 TRAVIS ST
Mailing Address - Street 2:SUITE 560
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-1312
Mailing Address - Country:US
Mailing Address - Phone:713-637-4408
Mailing Address - Fax:832-547-2221
Practice Address - Street 1:6655 TRAVIS ST
Practice Address - Street 2:SUITE 560
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-1312
Practice Address - Country:US
Practice Address - Phone:713-637-4408
Practice Address - Fax:832-547-2221
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-27
Last Update Date:2020-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM1566207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
021185T73Medicare PIN