Provider Demographics
NPI:1104235134
Name:DESAI, PRIYAL
Entity type:Individual
Prefix:
First Name:PRIYAL
Middle Name:
Last Name:DESAI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:PRIYAL
Other - Middle Name:
Other - Last Name:DESAI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:4301 W WILLIAM CANNON DR
Mailing Address - Street 2:STE B210
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78749-1473
Mailing Address - Country:US
Mailing Address - Phone:512-328-0015
Mailing Address - Fax:
Practice Address - Street 1:4301 W WILLIAM CANNON DR
Practice Address - Street 2:STE B210
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78749-1473
Practice Address - Country:US
Practice Address - Phone:512-328-0015
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-04
Last Update Date:2014-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8470T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist