Provider Demographics
NPI:1245542018
Name:CHENNANKARA, ASHLEY SUSAN (OD)
Entity type:Individual
Prefix:DR
First Name:ASHLEY
Middle Name:SUSAN
Last Name:CHENNANKARA
Suffix:
Gender:F
Credentials:OD
Other - Prefix:MISS
Other - First Name:ASHLEY
Other - Middle Name:SUSAN
Other - Last Name:KORUTHU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2401 S 31ST ST
Mailing Address - Street 2:
Mailing Address - City:TEMPLE
Mailing Address - State:TX
Mailing Address - Zip Code:76508-0002
Mailing Address - Country:US
Mailing Address - Phone:254-724-7784
Mailing Address - Fax:254-724-7791
Practice Address - Street 1:440 W LYNDON B JOHNSON FWY STE 300
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75063-3841
Practice Address - Country:US
Practice Address - Phone:214-574-9600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-09
Last Update Date:2017-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7549TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist