Provider Demographics
NPI:1366165904
Name:DHILLON, GURPARTAP (OD)
Entity type:Individual
Prefix:
First Name:GURPARTAP
Middle Name:
Last Name:DHILLON
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 1:4215 N MAJOR DR APT 1405
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77713-9709
Mailing Address - Country:US
Mailing Address - Phone:409-273-6189
Mailing Address - Fax:
Practice Address - Street 1:5910A MUELA CREEK DR
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77706-1009
Practice Address - Country:US
Practice Address - Phone:409-899-9999
Practice Address - Fax:409-892-6587
Is Sole Proprietor?:No
Enumeration Date:2022-09-20
Last Update Date:2022-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10523T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist