Provider Demographics
NPI:1962954735
Name:FARMER, ZELMIRA (OD)
Entity type:Individual
Prefix:
First Name:ZELMIRA
Middle Name:
Last Name:FARMER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:ZELMIRA
Other - Middle Name:
Other - Last Name:CANTU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:460 DOGWOOD SOUTH LN
Mailing Address - Street 2:
Mailing Address - City:HAUGHTON
Mailing Address - State:LA
Mailing Address - Zip Code:71037-8551
Mailing Address - Country:US
Mailing Address - Phone:623-523-4049
Mailing Address - Fax:
Practice Address - Street 1:16929 EL CAMINO REAL
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77058-2614
Practice Address - Country:US
Practice Address - Phone:346-230-7273
Practice Address - Fax:832-224-4258
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-27
Last Update Date:2021-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9106T152W00000X
LA1846-780AT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX421743201Medicaid