Healthcare Provider Details

I. General information

NPI: 1245069467
Provider Name (Legal Business Name): EURIKA RAJBANSHI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2024
Last Update Date: 07/27/2024
Certification Date: 07/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3801 W 15TH ST STE A-110
PLANO TX
75075-4737
US

IV. Provider business mailing address

3815 SMUGGLER MINE ST
AUBREY TX
76227-4897
US

V. Phone/Fax

Practice location:
  • Phone: 972-758-0625
  • Fax:
Mailing address:
  • Phone: 469-464-7095
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License Number11234
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number11234
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: