Provider Demographics
NPI:1952393373
Name:KRISHNAN, RAVINDERAN (MD)
Entity type:Individual
Prefix:DR
First Name:RAVINDERAN
Middle Name:
Last Name:KRISHNAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:RAVI
Other - Middle Name:
Other - Last Name:KRISHNAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:5729 ESPLANADE DR
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78414-4138
Mailing Address - Country:US
Mailing Address - Phone:361-991-3800
Mailing Address - Fax:361-991-6510
Practice Address - Street 1:5729 ESPLANADE DR
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78414-4138
Practice Address - Country:US
Practice Address - Phone:361-991-3800
Practice Address - Fax:361-991-6510
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-22
Last Update Date:2023-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK3598207W00000X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX88362GOtherBLUE CROSS BLUE SHIELD
TX080060901Medicaid
TX3372464OtherBLUE CROSS BLUE SHIELD
TX00171KMedicare ID - Type Unspecified
TXF72464Medicare UPIN
TX83220JMedicare ID - Type Unspecified