Active NPI
Marcus Piccolo, O.D.
- Optometrist
- Houston, TX
National Provider Identifier
1184627416
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 2801
- Practice address
- 4401 Martin Luther King Blvd
Houston, TX 77204-2020 - Phone
- (713) 743-2020
- Fax
- (713) 743-0963
- NPI assigned
- May 31, 2005
- Last updated
- May 17, 2022
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 2801TG | TX | |
| Optometrist | 152W00000X | 2801 | TX | Primary |
Addresses
Primary practice location
4401 Martin Luther King Blvd
Houston, TX 77204-2020
Mailing address
4401 Martin Luther King Blvd
Houston, TX 77204-2020
Phone (713) 743-2020
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 127241101 | Medicaid | TX | |
| 127241103 | Medicaid | TX |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2801 | TX | MD | Chiropractor |
| 2801TG | TX | MD | Optometrist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Marcus G. Piccolo, OD, PLLC | Optometrist | Past | Accepting new patients |
| Christine a Tyler OD PA | Optometrist | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1117497600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1652745600000",
"number": "1184627416",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4401 MARTIN LUTHER KING BLVD",
"city": "HOUSTON",
"state": "TX",
"postal_code": "772042020",
"telephone_number": "713-743-2020",
"fax_number": "713-743-0963"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4401 MARTIN LUTHER KING BLVD",
"city": "HOUSTON",
"state": "TX",
"postal_code": "772042020",
"telephone_number": "713-743-2020",
"fax_number": "713-743-0963"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PICCOLO",
"first_name": "MARCUS",
"name_prefix": "Dr.",
"credential": "O.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-05-31",
"last_updated": "2022-05-17",
"certification_date": "2022-05-17",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "TX",
"license": "2801TG",
"primary": false
},
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "TX",
"license": "2801",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "127241101",
"state": "TX"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "127241103",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}Other providers in Houston, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 17, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.