Healthcare Provider Details

I. General information

NPI: 1669406021
Provider Name (Legal Business Name): MILIND L DESAI O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 11/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11232 W POINT DR SUITE A
KNOXVILLE TN
37934-2837
US

IV. Provider business mailing address

11232 W POINT DR SUITE A
KNOXVILLE TN
37934-2837
US

V. Phone/Fax

Practice location:
  • Phone: 865-966-8255
  • Fax: 865-966-8257
Mailing address:
  • Phone: 865-966-8255
  • Fax: 865-966-8257

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License NumberT1971
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: