Provider Demographics
NPI:1578964763
Name:JOHN, RESHMA (OD)
Entity Type:Individual
Prefix:
First Name:RESHMA
Middle Name:
Last Name:JOHN
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 1:500 RICHLAND BLVD
Mailing Address - Street 2:
Mailing Address - City:PROSPER
Mailing Address - State:TX
Mailing Address - Zip Code:75078
Mailing Address - Country:US
Mailing Address - Phone:214-305-5904
Mailing Address - Fax:469-715-6819
Practice Address - Street 1:500 RICHLAND BLVD
Practice Address - Street 2:
Practice Address - City:PROSPER
Practice Address - State:TX
Practice Address - Zip Code:75078-7507
Practice Address - Country:US
Practice Address - Phone:214-305-5904
Practice Address - Fax:214-305-5904
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-08
Last Update Date:2018-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8522TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
1578964763OtherNPPES