=====================================================
General NPI Number Information
=====================================================
NPI Number | 1396191292
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DEEPAK N KOTECHA, OD, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/10/2016
-----------------------------------------------------
Last Update Date | 03/29/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3897 SOUTHWEST FWY
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77027-7515
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-552-9400
-----------------------------------------------------
Fax | 713-552-9447
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3897 SOUTHWEST FWY
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77027-7515
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-552-9400
-----------------------------------------------------
Fax | 713-552-9447
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. DEEPAK NARANDAS KOTECHA
-----------------------------------------------------
Credential | O.D.
-----------------------------------------------------
Telephone | 713-552-9400
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 04108TG
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------