Provider Demographics
NPI:1881225605
Name:MAGNOLIA EYE CLINIC PA
Entity Type:Organization
Organization Name:MAGNOLIA EYE CLINIC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RAVINDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:KANKARIA
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:281-252-6060
Mailing Address - Street 1:18010 FM 1488 RD STE 100
Mailing Address - Street 2:
Mailing Address - City:MAGNOLIA
Mailing Address - State:TX
Mailing Address - Zip Code:77354-8562
Mailing Address - Country:US
Mailing Address - Phone:281-252-6060
Mailing Address - Fax:281-259-7502
Practice Address - Street 1:18010 FM 1488 RD STE 100
Practice Address - Street 2:
Practice Address - City:MAGNOLIA
Practice Address - State:TX
Practice Address - Zip Code:77354-8562
Practice Address - Country:US
Practice Address - Phone:281-252-6060
Practice Address - Fax:281-259-7502
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-30
Last Update Date:2020-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty