Provider Demographics
NPI:1710086368
Name:RAVI KRISHNAN MD PA
Entity Type:Organization
Organization Name:RAVI KRISHNAN MD PA
Other - Org Name:EYE INSTITUTE OF CORPUS CHRISTI
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MD PA
Authorized Official - Prefix:DR
Authorized Official - First Name:RAVI
Authorized Official - Middle Name:
Authorized Official - Last Name:KRISHNAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:361-991-3800
Mailing Address - Street 1:5729 ESPLANADE DR
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78414-4138
Mailing Address - Country:US
Mailing Address - Phone:361-991-3800
Mailing Address - Fax:361-991-6510
Practice Address - Street 1:5729 ESPLANADE DR
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78414-4138
Practice Address - Country:US
Practice Address - Phone:361-991-3800
Practice Address - Fax:361-991-6510
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2023-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK3598207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX20CPOtherBCBS
TX080060901Medicaid