Individual
AMANDA POLACCO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OD
Contact information
Practice address
4401 MARTIN LUTHER KING BLVD, HOUSTON, TX 77204-2020
(713) 743-2020
(713) 743-0963
Mailing address
4401 MARTIN LUTHER KING BLVD., HOUSTON, TX 77204-2020
(713) 743-2020
(713) 743-0963
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
008677
NY
152W00000X
Optometrist
Primary
10375
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00244528
—
NY
05
—
429762401
—
TX
Enumeration date
08/23/2017
Last updated
05/12/2022
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