Provider Demographics
NPI:1336344282
Name:DESAI, DEVAL I (OD)
Entity Type:Individual
Prefix:DR
First Name:DEVAL
Middle Name:I
Last Name:DESAI
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:954 BERRYHILL LN
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27106-9831
Mailing Address - Country:US
Mailing Address - Phone:336-923-8260
Mailing Address - Fax:
Practice Address - Street 1:3320 SILAS CREEK PKWY
Practice Address - Street 2:300
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-3031
Practice Address - Country:US
Practice Address - Phone:336-760-2169
Practice Address - Fax:336-760-2385
Is Sole Proprietor?:No
Enumeration Date:2007-06-20
Last Update Date:2010-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4570152W00000X
NC2059152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist