Individual provider Active NPI

Divya Rajendra Vankawala, OD

  • Optometrist
  • Cleveland, OH
National Provider Identifier
1366972101
Registry record updated Jan 13, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
9322TG Issued in TX
Practice address
10701 East Boulevard
Louis Stokes Vamc
Cleveland, OH 44106
Phone
(216) 791-3800
NPI assigned
Jun 14, 2017
Last updated
Jan 13, 2020By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 13, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 9322TG TX Primary

Addresses

Primary practice location

10701 East Boulevard
Louis Stokes Vamc
Cleveland, OH 44106

Mailing address

2724 Vela
Grand Prairie, TX 75054-5537
Phone (817) 832-7719

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20191021002417 TX Practitioner - Optometry 7911239132 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
9322TGTXMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Focal Point Eye Care LLC CurrentSince Aug 1, 2019 Accepting new patients

Locations

27000 Tomball Pkwy
Ste A
Tomball, TX 77375
Phone (225) 368-6300

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1497398400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1578873600000",
    "number": "1366972101",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2724 VELA",
            "city": "GRAND PRAIRIE",
            "state": "TX",
            "postal_code": "750545537",
            "telephone_number": "817-832-7719"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10701 EAST BOULEVARD",
            "address_2": "LOUIS STOKES VAMC",
            "city": "CLEVELAND",
            "state": "OH",
            "postal_code": "44106",
            "telephone_number": "216-791-3800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VANKAWALA",
        "first_name": "DIVYA",
        "middle_name": "RAJENDRA",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-06-14",
        "last_updated": "2020-01-13",
        "certification_date": "2020-01-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "TX",
            "license": "9322TG",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Cleveland, OH

Sources for this page

Verify at the official NPI Registry.