Provider Demographics
NPI:1063490399
Name:DAMANI, RUCHIRA M (OD)
Entity Type:Individual
Prefix:DR
First Name:RUCHIRA
Middle Name:M
Last Name:DAMANI
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:RUCHIRA
Other - Middle Name:M
Other - Last Name:DAMANI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:11150 BROADWAY ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-2473
Mailing Address - Country:US
Mailing Address - Phone:713-436-6000
Mailing Address - Fax:713-436-6004
Practice Address - Street 1:11150 BROADWAY ST
Practice Address - Street 2:SUITE 100
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77584-2473
Practice Address - Country:US
Practice Address - Phone:713-436-6000
Practice Address - Fax:713-436-6004
Is Sole Proprietor?:No
Enumeration Date:2006-01-06
Last Update Date:2013-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6088TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXV04069Medicare UPIN