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General NPI Number Information
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NPI Number | 1578175725
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Entity Type | Individual
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Provider Name | TANYA KOHLI OD
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Gender | Female
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Dates
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Enumeration Date | 08/19/2020
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Last Update Date | 07/23/2021
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Provider Practice Location Address
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Address Line | 13343 N US HIGHWAY 183 STE 215
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City | AUSTIN
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State | TX
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Zip | 78750-7167
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Country | US
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Telephone | 972-795-4579
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Fax |
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Provider Business Mailing Address
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Address Line | 4711 E RIVERSIDE DR APT 2428
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City | AUSTIN
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State | TX
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Zip | 78741-5045
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Country | US
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Telephone | 972-795-4579
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Fax |
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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 | 9779T
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 152WS0006X
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Taxonomy Name | Sports Vision Optometrist
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License Number | 9779T
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 152WV0400X
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Taxonomy Name | Vision Therapy Optometrist
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License Number | 9779T
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License Number State | TX
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