Provider Demographics
NPI:1174806640
Name:FADEL EYE PRO, INC.
Entity type:Organization
Organization Name:FADEL EYE PRO, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:EMIL
Authorized Official - Middle Name:B
Authorized Official - Last Name:FADEL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:512-345-5642
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-21
Last Update Date:2023-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No152WV0400XEye and Vision Services ProvidersOptometristVision TherapyGroup - Single Specialty