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Organization
TEXAS STATE OPTICAL
Active
Organization
TEXAS STATE OPTICAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MICHAEL E SIEGEL OD (OWNER)
(713) 681-2467
Entity
Organization
Contact information
Practice address
564 NORTHWEST MALL, HOUSTON, TX 77092-8544
(713) 681-2467
(713) 681-0537
Mailing address
564 NORTHWEST MALL, HOUSTON, TX 77092-8544
(713) 681-2467
(713) 681-0537
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2141
TX
332H00000X
Eyewear Supplier
2141
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
019563801
MEDICAID
TX
01
—
143837
EYE MED
TX
01
—
16114
SPECTERA
TX
01
—
5595
SAFEGAURD
TX
01
—
6306
AVESIS
TX
01
—
902815
BLOCK VISION
TX
05
—
G000E92A2
—
TX
01
—
QMP000003344370
MOLINA
TX
Enumeration date
03/22/2007
Last updated
07/17/2008
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