Provider Demographics
NPI:1073374203
Name:FAKHRI RETINA PLLC
Entity Type:Organization
Organization Name:FAKHRI RETINA PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MURTAZA
Authorized Official - Middle Name:MUSTAFA
Authorized Official - Last Name:MANDVIWALA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:832-978-2273
Mailing Address - Street 1:13406 MEDICAL COMPLEX DR STE 110
Mailing Address - Street 2:
Mailing Address - City:TOMBALL
Mailing Address - State:TX
Mailing Address - Zip Code:77375-3330
Mailing Address - Country:US
Mailing Address - Phone:832-978-2273
Mailing Address - Fax:
Practice Address - Street 1:13406 MEDICAL COMPLEX DR STE 110
Practice Address - Street 2:
Practice Address - City:TOMBALL
Practice Address - State:TX
Practice Address - Zip Code:77375-3330
Practice Address - Country:US
Practice Address - Phone:832-978-2273
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-16
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0132XAmbulatory Health Care FacilitiesClinic/CenterOphthalmologic Surgery