Healthcare Provider Details

I. General information

NPI: 1356175467
Provider Name (Legal Business Name): RAMA ALDARKAZANLY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/29/2024
Last Update Date: 09/04/2024
Certification Date: 09/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

440 W LYNDON B JOHNSON FWY
IRVING TX
75063-3768
US

IV. Provider business mailing address

440 W LYNDON B JOHNSON FWY
IRVING TX
75063-3768
US

V. Phone/Fax

Practice location:
  • Phone: 972-254-4297
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number11246
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License Number11246
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code152WS0006X
TaxonomySports Vision Optometrist
License Number11246
License Number StateTX
# 4
Primary TaxonomyN
Taxonomy Code152WV0400X
TaxonomyVision Therapy Optometrist
License Number11246
License Number StateTX
# 5
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number11246
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: