Provider Demographics
NPI:1831314061
Name:DESAI, ANAMIKA (OD)
Entity Type:Individual
Prefix:DR
First Name:ANAMIKA
Middle Name:
Last Name:DESAI
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 1:3 VOSS PARK DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77024-3125
Mailing Address - Country:US
Mailing Address - Phone:469-767-7408
Mailing Address - Fax:281-372-8129
Practice Address - Street 1:14754 MEMORIAL DR STE 300
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77079-5276
Practice Address - Country:US
Practice Address - Phone:281-372-8129
Practice Address - Fax:281-372-8171
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-14
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6762TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX20-3748717OtherTAX ID
TX20-3748717OtherTAX ID