Healthcare Provider Details

I. General information

NPI: 1023222072
Provider Name (Legal Business Name): DAVEN JOSHI O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2007
Last Update Date: 08/24/2025
Certification Date: 08/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 W STATE HIGHWAY 114
GRAPEVINE TX
76051-8651
US

IV. Provider business mailing address

405 MANDERS CT
IRVING TX
75063-5351
US

V. Phone/Fax

Practice location:
  • Phone: 817-251-1091
  • Fax:
Mailing address:
  • Phone: 214-636-2297
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number6351
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: