Provider Demographics
NPI:1780772442
Name:DESAI, TORAL N (OD)
Entity type:Individual
Prefix:DR
First Name:TORAL
Middle Name:N
Last Name:DESAI
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 1:2629 MCKINLEY PL
Mailing Address - Street 2:
Mailing Address - City:BEAVERCREEK
Mailing Address - State:OH
Mailing Address - Zip Code:45431
Mailing Address - Country:US
Mailing Address - Phone:937-689-9029
Mailing Address - Fax:
Practice Address - Street 1:3464 PENTAGON PARK BLVD
Practice Address - Street 2:
Practice Address - City:BEAVERCREEK
Practice Address - State:OH
Practice Address - Zip Code:45431
Practice Address - Country:US
Practice Address - Phone:937-429-4060
Practice Address - Fax:937-429-9675
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2021-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5546152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2679589Medicaid
V10819Medicare UPIN
OH4198281Medicare PIN