Provider Demographics
NPI:1255151841
Name:BHAIDANI, SIMBRAN (OD)
Entity type:Individual
Prefix:
First Name:SIMBRAN
Middle Name:
Last Name:BHAIDANI
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 1:2210 W DALLAS ST APT 821
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77019-4353
Mailing Address - Country:US
Mailing Address - Phone:512-983-2019
Mailing Address - Fax:
Practice Address - Street 1:6565 WEST LOOP S STE 650
Practice Address - Street 2:
Practice Address - City:BELLAIRE
Practice Address - State:TX
Practice Address - Zip Code:77401-3505
Practice Address - Country:US
Practice Address - Phone:713-797-1010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-16
Last Update Date:2024-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11108T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist