Provider Demographics
NPI:1578564530
Name:RAIZADA, VIVEK (MD)
Entity Type:Individual
Prefix:DR
First Name:VIVEK
Middle Name:
Last Name:RAIZADA
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3345 PLAZA 10 DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77707-2553
Mailing Address - Country:US
Mailing Address - Phone:409-833-0444
Mailing Address - Fax:409-833-9039
Practice Address - Street 1:3345 PLAZA 10 DR
Practice Address - Street 2:SUITE B
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77707-2554
Practice Address - Country:US
Practice Address - Phone:409-833-0444
Practice Address - Fax:409-833-9039
Is Sole Proprietor?:No
Enumeration Date:2005-08-02
Last Update Date:2009-12-15
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Provider Licenses
StateLicense IDTaxonomies
TX062705100105207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX176915001Medicaid
TX8D8658Medicare PIN
TX176915001Medicaid