Organization
LONE STAR ORTHOTICS, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN M. WALLACE CO (PRESIDENT)
(713) 747-1000
Entity
Organization
Contact information
Practice address
8399 ALMEDA RD STE L, HOUSTON, TX 77054-7105
(713) 747-1000
(713) 747-1022
Mailing address
8399 ALMEDA RD STE L, HOUSTON, TX 77054-7105
(713) 747-1000
(713) 747-1022
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
000059
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
531643
BLUE CROSS BLUE SHIELD
TX
Enumeration date
12/13/2006
Last updated
08/22/2020
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