Provider Demographics
NPI:1396850319
Name:DESAI, VIRAL (OD)
Entity Type:Individual
Prefix:
First Name:VIRAL
Middle Name:
Last Name:DESAI
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 1:5610 W GRAND PKWY S
Mailing Address - Street 2:STE 500
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77406-5801
Mailing Address - Country:US
Mailing Address - Phone:281-232-2024
Mailing Address - Fax:281-232-2013
Practice Address - Street 1:5610 W GRAND PKWY S
Practice Address - Street 2:STE 500
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77406-5801
Practice Address - Country:US
Practice Address - Phone:281-232-2024
Practice Address - Fax:281-232-2013
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-20
Last Update Date:2010-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6210TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX6210TGOtherLICENSE
8F9966Medicare UPIN