Basic Information
| Provider Information | |||||||||
| NPI: | 1396730107 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JOSEPH | ||||||||
| FirstName: | JIMMY | ||||||||
| MiddleName: | V | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | O.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6210 DUKE TRAIL LN | ||||||||
| Address2: | |||||||||
| City: | SUGAR LAND | ||||||||
| State: | TX | ||||||||
| PostalCode: | 774794465 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2154799112 | ||||||||
| FaxNumber: | 2812864344 | ||||||||
| Practice Location | |||||||||
| Address1: | 6026 HIGHWAY 6 | ||||||||
| Address2: | |||||||||
| City: | MISSOURI CITY | ||||||||
| State: | TX | ||||||||
| PostalCode: | 774594163 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2814992600 | ||||||||
| FaxNumber: | 2814996556 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/19/2005 | ||||||||
| LastUpdateDate: | 10/03/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 6785TG | TX | Y | Eye and Vision Services Providers | Optometrist |
No ID Information.