Basic Information
| Provider Information | |||||||||
| NPI: | 1770710394 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GIRIDHAR | ||||||||
| FirstName: | PRASHANTHI | ||||||||
| MiddleName: | JAGANNATHAN | ||||||||
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| Credential: | M.D | ||||||||
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| OtherLastName: | JAGANANTHAN | ||||||||
| OtherFirstName: | PRASHANTHI | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | PO BOX 845347 | ||||||||
| Address2: | |||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752845347 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 5323 HARRY HINES BLVD | ||||||||
| Address2: | |||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 753907208 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2146452020 | ||||||||
| FaxNumber: | 2146450078 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/22/2009 | ||||||||
| LastUpdateDate: | 06/30/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | BP1-0034031 | TX | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207W00000X | P6394 | TX | Y | Allopathic & Osteopathic Physicians | Ophthalmology |
No ID Information.