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General NPI Number Information
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NPI Number | 1912909003
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Entity Type | Individual
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Provider Name | SRIYUTA THOTA O.D.
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Gender | Female
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Dates
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Enumeration Date | 06/02/2005
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Last Update Date | 09/02/2025
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Provider Practice Location Address
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Address Line | 21502 MERCHANTS WAY
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City | KATY
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State | TX
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Zip | 77449-2517
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Country | US
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Telephone | 281-579-6777
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Fax | 281-578-6534
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Provider Business Mailing Address
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Address Line | 27127 HORIZON BAY LN
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City | KATY
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State | TX
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Zip | 77494-7829
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Country | US
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Telephone | 281-989-3155
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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 | 6263TG
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License Number State | TX
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