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General NPI Number Information
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NPI Number | 1013180116
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Entity Type | Organization
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Legal Business Name | FARESH MEHTA, O.D., P.A.
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Dates
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Enumeration Date | 04/09/2008
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Last Update Date | 12/13/2010
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Provider Practice Location Address
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Address Line | 2121 HIGHWAY 146 BYP
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City | LIBERTY
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State | TX
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Zip | 77575-6000
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Country | US
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Telephone | 936-336-6510
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Fax |
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Provider Business Mailing Address
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Address Line | 2121 HIGHWAY 146 BYP
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City | LIBERTY
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State | TX
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Zip | 77575-6000
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Country | US
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Telephone | 936-336-6510
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Fax |
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | DR. FARESH S MEHTA
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Credential | O.D.
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Telephone | 936-336-6510
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152WC0802X
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Taxonomy Name | Corneal and Contact Management Optometrist
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License Number | 5983TG
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License Number State | TX
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