Provider Demographics
NPI:1144581109
Name:VELAZQUEZ, IVAN (OD)
Entity Type:Individual
Prefix:DR
First Name:IVAN
Middle Name:
Last Name:VELAZQUEZ
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18802 UNIVERSITY BLVD STE 155
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479-6851
Mailing Address - Country:US
Mailing Address - Phone:346-707-2020
Mailing Address - Fax:346-375-5095
Practice Address - Street 1:18802 UNIVERSITY BLVD STE 155
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77479-6851
Practice Address - Country:US
Practice Address - Phone:346-707-2020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-06
Last Update Date:2022-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7811TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist