Healthcare Provider Details

I. General information

NPI: 1043873128
Provider Name (Legal Business Name): GINA MAHATMA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2019
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

DEAN MCGEE EYE INSTITUTE, 608 STANTON L. YOUNG BLVD
OKLAHOMA CITY OK
73104
US

IV. Provider business mailing address

1701 W ROYAL LN STE 200
IRVING TX
75063-3232
US

V. Phone/Fax

Practice location:
  • Phone: 405-271-6060
  • Fax:
Mailing address:
  • Phone: 972-331-1599
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License Number322431
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: