Provider Demographics
NPI:1467813014
Name:FABRYGEL, BETHANY LEIGH (OD)
Entity Type:Individual
Prefix:
First Name:BETHANY
Middle Name:LEIGH
Last Name:FABRYGEL
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 1:3303 STONEY BROOK DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77063-6163
Mailing Address - Country:US
Mailing Address - Phone:361-676-9368
Mailing Address - Fax:
Practice Address - Street 1:17520 SOUTHWEST FWY # 2359
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77479-2359
Practice Address - Country:US
Practice Address - Phone:281-607-4545
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-10
Last Update Date:2020-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15427TLG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist