Provider Demographics
NPI:1598919227
Name:PRAMUKH DRASHTI PA
Entity Type:Organization
Organization Name:PRAMUKH DRASHTI PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:VIRAL
Authorized Official - Middle Name:A
Authorized Official - Last Name:DESAI
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:281-232-2024
Mailing Address - Street 1:5610 W GRAND PKWY S
Mailing Address - Street 2:SUITE 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:SUITE 500
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77406-5880
Practice Address - Country:US
Practice Address - Phone:281-232-2024
Practice Address - Fax:281-232-2013
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-07
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX06210TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX06210TGOtherTEXAS OPTOMETRY LICENSE
TXMD0884230OtherDRUG ENFORCEMENT ADMINISTRATION NUMBER
TXMD0884230OtherDRUG ENFORCEMENT ADMINISTRATION NUMBER
TX0A0326Medicare UPIN