Provider Demographics
NPI:1104814219
Name:REDDY, ARCHANA VENUMBAKA (MD)
Entity type:Individual
Prefix:DR
First Name:ARCHANA
Middle Name:VENUMBAKA
Last Name:REDDY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5240 E KNIGHT DR
Mailing Address - Street 2:STE 104
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85712-2183
Mailing Address - Country:US
Mailing Address - Phone:520-888-6600
Mailing Address - Fax:
Practice Address - Street 1:5240 E KNIGHT DR
Practice Address - Street 2:STE 104
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-2183
Practice Address - Country:US
Practice Address - Phone:520-888-6600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-12
Last Update Date:2021-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXR7094207WX0120X, 207W00000X
OH35-08-1577-R207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207WX0120XAllopathic & Osteopathic PhysiciansOphthalmologyCornea and External Diseases Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1770753519OtherGROUP NPI
NV107993Medicare UPIN
OH4134851Medicare ID - Type Unspecified