Provider Demographics
NPI:1124600564
Name:CANYON LAKE EYE CARE PLLC
Entity Type:Organization
Organization Name:CANYON LAKE EYE CARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SUNDIP
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:830-907-2813
Mailing Address - Street 1:1387 SATTLER RD UNIT A
Mailing Address - Street 2:
Mailing Address - City:NEW BRAUNFELS
Mailing Address - State:TX
Mailing Address - Zip Code:78132-2306
Mailing Address - Country:US
Mailing Address - Phone:830-907-2813
Mailing Address - Fax:866-772-0758
Practice Address - Street 1:1387 SATTLER RD UNIT A
Practice Address - Street 2:
Practice Address - City:NEW BRAUNFELS
Practice Address - State:TX
Practice Address - Zip Code:78132-2306
Practice Address - Country:US
Practice Address - Phone:830-907-2813
Practice Address - Fax:866-772-0758
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-26
Last Update Date:2021-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty