Provider Demographics
NPI:1669229183
Name:MISTRY, KARISHMA JAYESH (OD)
Entity type:Individual
Prefix:DR
First Name:KARISHMA
Middle Name:JAYESH
Last Name:MISTRY
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 1:1053 W GLENMERE DR
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224-7580
Mailing Address - Country:US
Mailing Address - Phone:831-578-5926
Mailing Address - Fax:
Practice Address - Street 1:857 N DOBSON RD
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85201-7585
Practice Address - Country:US
Practice Address - Phone:831-578-5926
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-02
Last Update Date:2024-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZOPT-002783152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty