=====================================================
General NPI Number Information
=====================================================
NPI Number | 1306930482
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BITA ESMAELI M.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/03/2006
-----------------------------------------------------
Last Update Date | 05/02/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 21009 KUYKENDAHL RD STE A
-----------------------------------------------------
City | SPRING
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77379-3310
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 832-663-6566
-----------------------------------------------------
Fax | 832-663-6550
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 21009 KUYKENDAHL RD STE A
-----------------------------------------------------
City | SPRING
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77379-3310
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 832-663-6566
-----------------------------------------------------
Fax | 832-663-6550
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207W00000X
-----------------------------------------------------
Taxonomy Name | Ophthalmology Physician
-----------------------------------------------------
License Number | K6579
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------