Provider Demographics
NPI:1912018425
Name:TEJANI, MUMTAZ PYARALI (OD)
Entity type:Individual
Prefix:DR
First Name:MUMTAZ
Middle Name:PYARALI
Last Name:TEJANI
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 1:831 CEDARBLUFF DR
Mailing Address - Street 2:
Mailing Address - City:ROCKWALL
Mailing Address - State:TX
Mailing Address - Zip Code:75087-6545
Mailing Address - Country:US
Mailing Address - Phone:972-896-9788
Mailing Address - Fax:
Practice Address - Street 1:494 W INTERSTATE 30
Practice Address - Street 2:
Practice Address - City:ROYSE CITY
Practice Address - State:TX
Practice Address - Zip Code:75189-7527
Practice Address - Country:US
Practice Address - Phone:972-635-2520
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2024-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6622TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8C7353Medicare ID - Type Unspecified
TXV02076Medicare UPIN