Provider Demographics
NPI:1740649128
Name:DEVAL I DESAI OD PLLC
Entity type:Organization
Organization Name:DEVAL I DESAI OD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DEVAL
Authorized Official - Middle Name:INDRA
Authorized Official - Last Name:DESAI
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:336-587-6584
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:
Mailing Address - Fax:
Practice Address - Street 1:261 COOPER CREEK DR
Practice Address - Street 2:
Practice Address - City:MOCKSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27028-5967
Practice Address - Country:US
Practice Address - Phone:336-751-2890
Practice Address - Fax:336-751-2442
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-15
Last Update Date:2016-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty