=====================================================
General NPI Number Information
=====================================================
NPI Number | 1831314061
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ANAMIKA DESAI O.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/14/2007
-----------------------------------------------------
Last Update Date | 03/17/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 14754 MEMORIAL DR STE 300
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77079-5276
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-372-8129
-----------------------------------------------------
Fax | 281-372-8171
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3 VOSS PARK DR
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77024-3125
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 469-767-7408
-----------------------------------------------------
Fax | 281-372-8129
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 6762TG
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------