Healthcare Provider Details

I. General information

NPI: 1396298428
Provider Name (Legal Business Name): SUPRIYA KRISHNAN OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2016
Last Update Date: 09/11/2025
Certification Date: 09/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14634 MEMORIAL DR
HOUSTON TX
77079
US

IV. Provider business mailing address

14634 MEMORIAL DR
HOUSTON TX
77079-7517
US

V. Phone/Fax

Practice location:
  • Phone: 281-741-7295
  • Fax:
Mailing address:
  • Phone: 281-741-7295
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number8935TG
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code152WV0400X
TaxonomyVision Therapy Optometrist
License Number8935TG
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: