Provider Demographics
NPI:1285680033
Name:MEHTA, FARESH S (OD)
Entity Type:Individual
Prefix:DR
First Name:FARESH
Middle Name:S
Last Name:MEHTA
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2121 HWY 146 BYPASS
Mailing Address - Street 2:
Mailing Address - City:LIBERTY
Mailing Address - State:TX
Mailing Address - Zip Code:77575
Mailing Address - Country:US
Mailing Address - Phone:936-336-6510
Mailing Address - Fax:
Practice Address - Street 1:2121 HWY 146 BYPASS
Practice Address - Street 2:
Practice Address - City:LIBERTY
Practice Address - State:TX
Practice Address - Zip Code:77575
Practice Address - Country:US
Practice Address - Phone:936-336-6510
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2024-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5983TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX019093601Medicaid
TXG000094P2Medicaid
TX019093603Medicaid
TXG000094P2Medicaid