Provider Demographics
NPI:1255412383
Name:DIPAK R. KALANI, OD, PA
Entity type:Organization
Organization Name:DIPAK R. KALANI, OD, PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DIPAK
Authorized Official - Middle Name:R
Authorized Official - Last Name:KALANI
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:713-436-7544
Mailing Address - Street 1:11601 SHADOW CREEK PKWY
Mailing Address - Street 2:113
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584
Mailing Address - Country:US
Mailing Address - Phone:713-436-7544
Mailing Address - Fax:713-995-0548
Practice Address - Street 1:11601 SHADOW CREEK PKWY
Practice Address - Street 2:113
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77584
Practice Address - Country:US
Practice Address - Phone:713-436-7544
Practice Address - Fax:713-995-0548
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX06223TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX06223TGOtherTEXAS OPTOMETRY LICENSE
TX=========OtherTAX IDENTIFICATION NUMB