Provider Demographics
NPI:1730161506
Name:TJANDRA, EASTER WINDARTI (OD)
Entity type:Individual
Prefix:DR
First Name:EASTER
Middle Name:WINDARTI
Last Name:TJANDRA
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:PO BOX 250226
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75025-0226
Mailing Address - Country:US
Mailing Address - Phone:972-378-7979
Mailing Address - Fax:972-612-5955
Practice Address - Street 1:301 COIT RD
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75075-5711
Practice Address - Country:US
Practice Address - Phone:972-378-7979
Practice Address - Fax:972-612-5955
Is Sole Proprietor?:No
Enumeration Date:2005-11-17
Last Update Date:2009-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4355T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX000E75SMedicare ID - Type Unspecified