Basic Information
| Provider Information | |||||||||
| NPI: | 1346747870 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MOPURU | ||||||||
| FirstName: | RENUKA | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 650859 | ||||||||
| Address2: | DEPT 710 | ||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752651257 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4097476240 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2660 GULF FWY S | ||||||||
| Address2: | ENTRANCE B | ||||||||
| City: | LEAGUE CITY | ||||||||
| State: | TX | ||||||||
| PostalCode: | 775737757 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8325052400 | ||||||||
| FaxNumber: | 2813370843 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/11/2018 | ||||||||
| LastUpdateDate: | 08/01/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/01/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207W00000X | HSE26041 | FL | Y | Allopathic & Osteopathic Physicians | Ophthalmology |
No ID Information.