Provider Demographics
NPI:1972509164
Name:FADEL, EMIL B (OD)
Entity Type:Individual
Prefix:
First Name:EMIL
Middle Name:B
Last Name:FADEL
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10000 RESEARCH BLVD
Mailing Address - Street 2:STE 150
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759-5854
Mailing Address - Country:US
Mailing Address - Phone:512-345-5642
Mailing Address - Fax:512-345-1046
Practice Address - Street 1:10000 RESEARCH BLVD
Practice Address - Street 2:STE 150
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-5854
Practice Address - Country:US
Practice Address - Phone:512-345-5642
Practice Address - Fax:512-345-1046
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-22
Last Update Date:2019-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6350T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX159815301Medicaid
TXU95406Medicare UPIN
TX159815301Medicaid