MEDICARE: UNNI KRISHNAN NAIR M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207WX0009X	Glaucoma Specialist (Ophthalmology) Physician	N7466	TX
2	207W00000X	Ophthalmology Physician	N7466	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1376863662
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	UNNI KRISHNAN NAIR M.D.

Provider Business Mailing Address
First Line	:	1201 SUMMIT AVE
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76102-4413
Country	:	US
Telephone Number	:	817-332-2020
Fax Number	:	817-332-4797

Provider Business Practice Location Address
First Line	:	1201 SUMMIT AVE
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76102-4413
Country	:	US
Telephone Number	:	817-332-2020
Fax Number	:	817-332-4797

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/09/2010
Last Update Date	:	07/12/2017

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