Provider Demographics
NPI:1609806637
Name:DESAI, LINA M (OD)
Entity Type:Individual
Prefix:DR
First Name:LINA
Middle Name:M
Last Name:DESAI
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:11232 W POINT DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37934-2837
Mailing Address - Country:US
Mailing Address - Phone:865-777-2020
Mailing Address - Fax:865-966-8257
Practice Address - Street 1:11232 W POINT DR
Practice Address - Street 2:SUITE A
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37934-2837
Practice Address - Country:US
Practice Address - Phone:865-777-2020
Practice Address - Fax:865-966-8257
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2010-10-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TNT2234152WC0802X
CA11203T152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNU87180Medicare UPIN
TN103I410005Medicare PIN
TN3944620Medicare PIN