Doctor Name: | JAY S. PRAVDA |
NPI Number: | 1790805554 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | O.D. |
License Number: | 02295TG |
Business Practice Address: | 20811 Highway 59 N Suite 300 Humble, TX - 773382259 |
Business Phone Number: | 7139950042 |
Business Fax Number: | 7139950548 |
Mailing Address: | 20811 Highway 59 N, Suite 300 HUMBLE |
State: | TX |
Postal Code: | 773382259 |
Phone Number: | 7139950042 |
Fax Number: | 7139950548 |
NPI Enumeration Date: | 03/29/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 174400000X |
License Number: | 02295TG |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | TX |
Taxonomy Type: | Other Service Providers |
Taxonomy Classification: | Specialist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |