Provider Demographics
NPI:1568539286
Name:NOEL, JEFFREY M (OD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:M
Last Name:NOEL
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 E HIGHWAY 114 STE 180
Mailing Address - Street 2:
Mailing Address - City:TROPHY CLUB
Mailing Address - State:TX
Mailing Address - Zip Code:76262-6656
Mailing Address - Country:US
Mailing Address - Phone:682-831-0999
Mailing Address - Fax:
Practice Address - Street 1:2240 E HIGHWAY 114 STE 620
Practice Address - Street 2:
Practice Address - City:TROPHY CLUB
Practice Address - State:TX
Practice Address - Zip Code:76262-6728
Practice Address - Country:US
Practice Address - Phone:682-831-0999
Practice Address - Fax:682-831-0998
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2020-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX005588TG152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0191165 01Medicaid
TX00E54ZOtherBCBS
TX75-2935825OtherUNITED HEALTH CARE
TX9435338OtherPHCS
TX75-2935825OtherUNITED HEALTH CARE
TXU72766Medicare UPIN
TX00360EMedicare ID - Type Unspecified