Provider Demographics
NPI:1518963792
Name:MEHTA, SHUK-BING SUSIE (OD)
Entity Type:Individual
Prefix:
First Name:SHUK-BING
Middle Name:SUSIE
Last Name:MEHTA
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 1:2274 LONGSPUR LN
Mailing Address - Street 2:
Mailing Address - City:LEAGUE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77573-3912
Mailing Address - Country:US
Mailing Address - Phone:281-480-2727
Mailing Address - Fax:281-280-0489
Practice Address - Street 1:300 BAYBROOK MALL
Practice Address - Street 2:
Practice Address - City:FRIENDSWOOD
Practice Address - State:TX
Practice Address - Zip Code:77546-2711
Practice Address - Country:US
Practice Address - Phone:281-480-2727
Practice Address - Fax:281-280-0489
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-22
Last Update Date:2011-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2910TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX80101QOtherBCBS OF TEXAS
TXT90579Medicare UPIN
TX80996EMedicare ID - Type Unspecified