MEDICARE: RAVINDRA S. KANKARIA O.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	152W00000X	Optometrist	4103T	TX

General Provider Information

NPI Number	:	1558431643
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RAVINDRA S. KANKARIA O.D.

Provider Business Mailing Address
First Line	:	5164 ALDINE MAIL RD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77039-3802
Country	:	US
Telephone Number	:	281-449-7400
Fax Number	:	281-449-8020

Provider Business Practice Location Address
First Line	:	5164 ALDINE MAIL RD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77039-3802
Country	:	US
Telephone Number	:	281-449-7400
Fax Number	:	281-449-8020

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

Provider Enumeration Date	:	11/08/2006
Last Update Date	:	04/15/2011

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