Provider Demographics
NPI:1205044088
Name:MURINGATHUPARAMBIL, VALSA PATRIC (OD)
Entity Type:Individual
Prefix:DR
First Name:VALSA
Middle Name:PATRIC
Last Name:MURINGATHUPARAMBIL
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10320 BOULDER LN
Mailing Address - Street 2:APT # 1628
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78726-1835
Mailing Address - Country:US
Mailing Address - Phone:512-249-5956
Mailing Address - Fax:
Practice Address - Street 1:2604 N MAIN ST
Practice Address - Street 2:
Practice Address - City:BELTON
Practice Address - State:TX
Practice Address - Zip Code:76513-1545
Practice Address - Country:US
Practice Address - Phone:254-939-9555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6905TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist