Provider Demographics
NPI:1821379991
Name:LAURA A PELS
Entity Type:Organization
Organization Name:LAURA A PELS
Other - Org Name:COPPELL VISION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:PELS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:972-393-3937
Mailing Address - Street 1:541 E SANDY LAKE RD
Mailing Address - Street 2:
Mailing Address - City:COPPELL
Mailing Address - State:TX
Mailing Address - Zip Code:75019-3090
Mailing Address - Country:US
Mailing Address - Phone:972-393-3937
Mailing Address - Fax:972-304-4422
Practice Address - Street 1:541 E SANDY LAKE RD
Practice Address - Street 2:
Practice Address - City:COPPELL
Practice Address - State:TX
Practice Address - Zip Code:75019-3090
Practice Address - Country:US
Practice Address - Phone:972-393-3937
Practice Address - Fax:972-304-4422
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-02
Last Update Date:2011-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3083T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
81443OtherBLUECROSS BLUESHIELD OF TEXAS
1639263668OtherINDIVIDUAL NPI
TX1366533853OtherINDIVIDUAL NPI
81442OtherBLUECROSS BLUE SHIELD OF TEXAS
1639263668OtherINDIVIDUAL NPI
81442OtherBLUECROSS BLUE SHIELD OF TEXAS
P00917684Medicare PIN