Healthcare Provider Details

I. General information

NPI: 1902641848
Provider Name (Legal Business Name): RIYA V DESAI OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2024
Last Update Date: 07/01/2024
Certification Date: 07/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

930 COMMONWEALTH AVE
BOSTON MA
02215-1274
US

IV. Provider business mailing address

338 TAPPAN ST APT 2
BROOKLINE MA
02445-5320
US

V. Phone/Fax

Practice location:
  • Phone: 617-262-2020
  • Fax:
Mailing address:
  • Phone: 949-202-8055
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number5712
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: