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General NPI Number Information
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NPI Number | 1811233836
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Entity Type | Organization
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Legal Business Name | CUSTOM EYES OF PEARLAND, LLC
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Dates
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Enumeration Date | 12/19/2012
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Last Update Date | 03/16/2016
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Provider Practice Location Address
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Address Line | 11126 BROADWAY ST SUITE 200
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City | PEARLAND
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State | TX
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Zip | 77584-9754
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Country | US
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Telephone | 713-436-6000
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Fax | 713-436-6004
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Provider Business Mailing Address
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Address Line | 11150 BROADWAY ST SUITE 100
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City | PEARLAND
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State | TX
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Zip | 77584-2473
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Country | US
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Telephone | 713-436-6000
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Fax | 713-436-6004
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Authorized Official
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Title or Position | OD/OWNER
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Name | SEJAL P. PATEL
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Credential | OD
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Telephone | 713-436-6000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 7074T
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License Number State | TX
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