Provider Demographics
NPI:1366533853
Name:PELS, LAURA (OD)
Entity type:Individual
Prefix:DR
First Name:LAURA
Middle Name:
Last Name:PELS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:541 E SANDY LAKE RD
Mailing Address - Street 2:
Mailing Address - City:COPPELL
Mailing Address - State:TX
Mailing Address - Zip Code:75019-3090
Mailing Address - Country:US
Mailing Address - Phone:972-393-3937
Mailing Address - Fax:972-304-4422
Practice Address - Street 1:541 E SANDY LAKE RD
Practice Address - Street 2:
Practice Address - City:COPPELL
Practice Address - State:TX
Practice Address - Zip Code:75019-3090
Practice Address - Country:US
Practice Address - Phone:972-393-3937
Practice Address - Fax:972-304-4422
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2011-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3083T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1821379991OtherGROUP NPI
TX81442QOtherBLUE CROSS BLUE SHIELD
TX613961Medicare UPIN
TXP00917684Medicare PIN