Organization
DR. JASON IDICULLA O.D. PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JASON IDICULLA O.D. (OPTOMETRIST)
(954) 907-4966
Entity
Organization
Contact information
Practice address
3271 SOUTHWEST FWY, SUITE A, HOUSTON, TX 77027-7503
(954) 907-4966
Mailing address
2222 SMITH ST, APT. 434, HOUSTON, TX 77002-8735
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
8235TG
TX
Other
Enumeration date
11/24/2013
Last updated
11/24/2013
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