MEDICARE: GURPARTAP DHILLON OD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	10523T	TX

General Provider Information

NPI Number	:	1366165904
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GURPARTAP DHILLON OD

Provider Business Mailing Address
First Line	:	4215 N MAJOR DR APT 1405
Second Line	:
City	:	BEAUMONT
State	:	TX
Zip	:	77713-9709
Country	:	US
Telephone Number	:	409-273-6189
Fax Number	:

Provider Business Practice Location Address
First Line	:	5910A MUELA CREEK DR
Second Line	:
City	:	BEAUMONT
State	:	TX
Zip	:	77706-1009
Country	:	US
Telephone Number	:	409-899-9999
Fax Number	:	409-892-6587

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/20/2022
Last Update Date	:	09/20/2022

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Directions to “ GURPARTAP DHILLON OD” Practice Location

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