Provider Demographics
NPI:1649235862
Name:NAIDOO, SAMANTHA N (OD)
Entity Type:Individual
Prefix:MRS
First Name:SAMANTHA
Middle Name:N
Last Name:NAIDOO
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 1:3900 W WHEATLAND RD
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75237-3468
Mailing Address - Country:US
Mailing Address - Phone:972-780-7199
Mailing Address - Fax:972-780-9157
Practice Address - Street 1:3121 N GEORGE BUSH HWY
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75040-2752
Practice Address - Country:US
Practice Address - Phone:972-495-7772
Practice Address - Fax:972-495-9393
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-19
Last Update Date:2009-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6452TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX81126QOtherBLUE CROSS BLUE SHIELD TX
TX163978301Medicaid
TX8F7707Medicare PIN
TX163978301Medicaid