Healthcare Provider Details

I. General information

NPI: 1346747870
Provider Name (Legal Business Name): RENUKA MOPURU MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2018
Last Update Date: 10/07/2025
Certification Date: 10/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2660 GULF FWY S ENTRANCE B
LEAGUE CITY TX
77573-7757
US

IV. Provider business mailing address

PO BOX 650859 DEPT 710
DALLAS TX
75265-1257
US

V. Phone/Fax

Practice location:
  • Phone: 832-505-2400
  • Fax: 281-337-0843
Mailing address:
  • Phone: 409-747-6240
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberU6022
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License NumberU6022
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberHSE26041
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: