Provider Demographics
NPI:1013180116
Name:FARESH MEHTA, O.D., P.A.
Entity Type:Organization
Organization Name:FARESH MEHTA, O.D., P.A.
Other - Org Name:FARESH MEHTA, O.D., P.A.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:FARESH
Authorized Official - Middle Name:S
Authorized Official - Last Name:MEHTA
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:936-336-6510
Mailing Address - Street 1:2121 HIGHWAY 146 BYP
Mailing Address - Street 2:
Mailing Address - City:LIBERTY
Mailing Address - State:TX
Mailing Address - Zip Code:77575-6000
Mailing Address - Country:US
Mailing Address - Phone:936-336-6510
Mailing Address - Fax:
Practice Address - Street 1:2121 HIGHWAY 146 BYP
Practice Address - Street 2:
Practice Address - City:LIBERTY
Practice Address - State:TX
Practice Address - Zip Code:77575-6000
Practice Address - Country:US
Practice Address - Phone:936-336-6510
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-09
Last Update Date:2010-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5983TG152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXOA5358Medicare PIN