Provider Demographics
NPI:1972829646
Name:VELA, JAIME JOEL (OD)
Entity Type:Individual
Prefix:
First Name:JAIME
Middle Name:JOEL
Last Name:VELA
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:PO BOX 51286
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76206-1286
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:311 E CALIFORNIA ST
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:TX
Practice Address - Zip Code:76240-4005
Practice Address - Country:US
Practice Address - Phone:940-668-7500
Practice Address - Fax:940-665-7377
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-20
Last Update Date:2021-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX04567TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX037401902Medicaid
TX04567TGOtherSTATE LICENSE
TX04567TGOtherSTATE LICENSE