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General NPI Number Information
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NPI Number | 1457099251
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Entity Type | Individual
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Provider Name | AMISHA DESAI OD
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Gender | Female
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Dates
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Enumeration Date | 05/23/2022
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Last Update Date | 10/16/2025
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Provider Practice Location Address
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Address Line | 400 W ROUTE 38 UNIT 1365
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City | MOORESTOWN
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State | NJ
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Zip | 08057-3219
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Country | US
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Telephone | 856-787-0103
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Fax | 856-787-0914
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Provider Business Mailing Address
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Address Line | 400 W ROUTE 38 UNIT 1365
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City | MOORESTOWN
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State | NJ
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Zip | 08057-3219
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Country | US
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Telephone | 856-787-0103
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Fax | 856-787-0914
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 270A00711900
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License Number State | NJ
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