Provider Demographics
NPI:1639308760
Name:GAWELEK, MISTY (OD)
Entity Type:Individual
Prefix:DR
First Name:MISTY
Middle Name:
Last Name:GAWELEK
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 1:601 E FM 646 RD STE A
Mailing Address - Street 2:
Mailing Address - City:LEAGUE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77573-7478
Mailing Address - Country:US
Mailing Address - Phone:281-337-3344
Mailing Address - Fax:281-337-3340
Practice Address - Street 1:601 E FM 646 RD STE A
Practice Address - Street 2:
Practice Address - City:LEAGUE CITY
Practice Address - State:TX
Practice Address - Zip Code:77573-7478
Practice Address - Country:US
Practice Address - Phone:281-337-3344
Practice Address - Fax:281-337-3340
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-10
Last Update Date:2020-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2619152W00000X
TX9387TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist