Healthcare Provider Details

I. General information

NPI: 1376863662
Provider Name (Legal Business Name): UNNI KRISHNAN NAIR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2010
Last Update Date: 07/12/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 SUMMIT AVE
FORT WORTH TX
76102-4413
US

IV. Provider business mailing address

1201 SUMMIT AVE
FORT WORTH TX
76102-4413
US

V. Phone/Fax

Practice location:
  • Phone: 817-332-2020
  • Fax: 817-332-4797
Mailing address:
  • Phone: 817-332-2020
  • Fax: 817-332-4797

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207WX0009X
TaxonomyGlaucoma Specialist (Ophthalmology) Physician
License NumberN7466
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberN7466
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: