Provider Demographics
NPI:1255393757
Name:PATEL, SUNDIP R (OD)
Entity type:Individual
Prefix:
First Name:SUNDIP
Middle Name:R
Last Name:PATEL
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:1667 S IH 35
Mailing Address - Street 2:SUITE 101
Mailing Address - City:NEW BRAUNFELS
Mailing Address - State:TX
Mailing Address - Zip Code:78130-6851
Mailing Address - Country:US
Mailing Address - Phone:830-626-3017
Mailing Address - Fax:830-626-3019
Practice Address - Street 1:1209 S IH 35
Practice Address - Street 2:
Practice Address - City:NEW BRAUNFELS
Practice Address - State:TX
Practice Address - Zip Code:78130-5936
Practice Address - Country:US
Practice Address - Phone:830-626-3017
Practice Address - Fax:830-626-3019
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-03
Last Update Date:2016-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6692T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8F2272Medicare PIN
TXV08352Medicare UPIN