Provider Demographics
NPI:1144669110
Name:SATTAM, MINTRA (OD)
Entity type:Individual
Prefix:
First Name:MINTRA
Middle Name:
Last Name:SATTAM
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 1:6927 FM 1960 RD W
Mailing Address - Street 2:STE D
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77069-3701
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6927 FM 1960 RD W
Practice Address - Street 2:STE D
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77069-3701
Practice Address - Country:US
Practice Address - Phone:281-377-5256
Practice Address - Fax:281-397-0849
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-22
Last Update Date:2016-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8230152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist