Provider Demographics
NPI:1366283376
Name:VELASCO, ADRIAN ANDRES
Entity type:Individual
Prefix:
First Name:ADRIAN
Middle Name:ANDRES
Last Name:VELASCO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1148 W DALLAS ST
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77301-2208
Mailing Address - Country:US
Mailing Address - Phone:936-756-8622
Mailing Address - Fax:
Practice Address - Street 1:1148 W DALLAS ST
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77301-2208
Practice Address - Country:US
Practice Address - Phone:936-756-8622
Practice Address - Fax:936-756-8603
Is Sole Proprietor?:No
Enumeration Date:2024-06-04
Last Update Date:2024-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11152152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist