Provider Demographics
NPI:1366828857
Name:CUSTOM EYES OF MEMORIAL LLC
Entity Type:Organization
Organization Name:CUSTOM EYES OF MEMORIAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OD/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SEJAL
Authorized Official - Middle Name:P
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:OD/OWNER
Authorized Official - Phone:713-436-6000
Mailing Address - Street 1:8420 KATY FWY
Mailing Address - Street 2:SUITE512
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77024-1941
Mailing Address - Country:US
Mailing Address - Phone:713-436-6000
Mailing Address - Fax:713-436-6004
Practice Address - Street 1:8420 KATY FWY
Practice Address - Street 2:SUITE512
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77024-1941
Practice Address - Country:US
Practice Address - Phone:713-436-6000
Practice Address - Fax:713-436-6004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-06
Last Update Date:2015-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty