Provider Demographics
NPI:1174028922
Name:MADHOK, MANVI (OD)
Entity Type:Individual
Prefix:
First Name:MANVI
Middle Name:
Last Name:MADHOK
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:426 FOX TRL
Mailing Address - Street 2:
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75002-1709
Mailing Address - Country:US
Mailing Address - Phone:774-249-4302
Mailing Address - Fax:
Practice Address - Street 1:1721 N CUSTER RD
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75071-3274
Practice Address - Country:US
Practice Address - Phone:774-249-4302
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-26
Last Update Date:2018-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9388T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist