Provider Demographics
NPI:1700517737
Name:PRASHANT JYOTHI, OD
Entity type:Organization
Organization Name:PRASHANT JYOTHI, OD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PRASHANT
Authorized Official - Middle Name:
Authorized Official - Last Name:JYOTHI
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:972-841-3937
Mailing Address - Street 1:8989 SKILLMAN ST
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75243-8213
Mailing Address - Country:US
Mailing Address - Phone:972-248-4008
Mailing Address - Fax:
Practice Address - Street 1:8989 SKILLMAN ST
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75243-8213
Practice Address - Country:US
Practice Address - Phone:972-248-4008
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-21
Last Update Date:2022-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX019513301Medicaid