Provider Demographics
NPI:1356687263
Name:PATEL, SEJAL P (OD)
Entity Type:Individual
Prefix:
First Name:SEJAL
Middle Name:P
Last Name:PATEL
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 1:11126 BROADWAY ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-9754
Mailing Address - Country:US
Mailing Address - Phone:713-436-6000
Mailing Address - Fax:713-513-5797
Practice Address - Street 1:11126 BROADWAY ST
Practice Address - Street 2:SUITE 200
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77584-9754
Practice Address - Country:US
Practice Address - Phone:713-436-6000
Practice Address - Fax:713-513-5797
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-20
Last Update Date:2012-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7074T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX7074TOtherTEXAS OPTOMETRY LICENSE