Provider Demographics
NPI:1568062388
Name:MINATI DESAI ACHARYA, O.D., OPTOMETRIC CORPORATION
Entity Type:Organization
Organization Name:MINATI DESAI ACHARYA, O.D., OPTOMETRIC CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MINATI
Authorized Official - Middle Name:DESAI
Authorized Official - Last Name:ACHARYA
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:408-781-5716
Mailing Address - Street 1:117 PELTON CENTER WAY
Mailing Address - Street 2:
Mailing Address - City:SAN LEANDRO
Mailing Address - State:CA
Mailing Address - Zip Code:94577-4815
Mailing Address - Country:US
Mailing Address - Phone:408-781-5716
Mailing Address - Fax:
Practice Address - Street 1:117 PELTON CENTER WAY
Practice Address - Street 2:
Practice Address - City:SAN LEANDRO
Practice Address - State:CA
Practice Address - Zip Code:94577-4815
Practice Address - Country:US
Practice Address - Phone:408-781-5716
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-30
Last Update Date:2020-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty