Basic Information
| Provider Information | |||||||||
| NPI: | 1700833837 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DONTHI | ||||||||
| FirstName: | KIRAN | ||||||||
| MiddleName: | R | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 275 GRAHAM RD | ||||||||
| Address2: | STE 2 | ||||||||
| City: | CUYAHOGA FALLS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 442232259 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3309235123 | ||||||||
| FaxNumber: | 3309236654 | ||||||||
| Practice Location | |||||||||
| Address1: | 275 GRAHAM RD | ||||||||
| Address2: | STE 2 | ||||||||
| City: | CUYAHOGA FALLS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 442232259 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3309235123 | ||||||||
| FaxNumber: | 3309236654 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/26/2006 | ||||||||
| LastUpdateDate: | 06/07/2016 | ||||||||
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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 | 207W00000X | 35042811 | OH | Y | Allopathic & Osteopathic Physicians | Ophthalmology |
ID Information
| ID | Type | State | Issuer | Description | 0417454 | 05 | OH | MEDICAID |