Provider Demographics
NPI:1730613076
Name:DECORDOVA EYEWEAR LLC
Entity type:Organization
Organization Name:DECORDOVA EYEWEAR LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KERR-ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:HODGE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:281-763-2006
Mailing Address - Street 1:25510 BUFFALO SPRINGS CT
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77373-8445
Mailing Address - Country:US
Mailing Address - Phone:281-763-2006
Mailing Address - Fax:
Practice Address - Street 1:12230 WEST LAKE HOUSTON PARKWAY
Practice Address - Street 2:SUITE 155
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77044
Practice Address - Country:US
Practice Address - Phone:281-763-2006
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-13
Last Update Date:2017-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty