Healthcare Provider Details

I. General information

NPI: 1811584402
Provider Name (Legal Business Name): ANANYA SEN GUPTA OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/29/2020
Last Update Date: 08/18/2025
Certification Date: 08/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4850 MAIN ST
HOUSTON TX
77002-9718
US

IV. Provider business mailing address

1000 MAIN ST STE T10
HOUSTON TX
77002-6345
US

V. Phone/Fax

Practice location:
  • Phone: 713-523-5109
  • Fax: 713-523-1633
Mailing address:
  • Phone: 713-658-8301
  • Fax: 571-223-6780

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152WV0400X
TaxonomyVision Therapy Optometrist
License Number9978TG
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number9978
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: