Provider Demographics
NPI:1417469412
Name:SAMPAT, MEERA PATEL (OD)
Entity Type:Individual
Prefix:DR
First Name:MEERA
Middle Name:PATEL
Last Name:SAMPAT
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:MEERA
Other - Middle Name:SHAILESH
Other - Last Name:PATEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2511 W BRAKER LN APT 311
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78758-1212
Mailing Address - Country:US
Mailing Address - Phone:201-310-8697
Mailing Address - Fax:
Practice Address - Street 1:11200 LAKELINE MALL DR
Practice Address - Street 2:
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613-1501
Practice Address - Country:US
Practice Address - Phone:512-257-7070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-30
Last Update Date:2022-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG003500152W00000X
NJ27OA00677000152W00000X
TX10277TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist