Provider Demographics
NPI:1194341081
Name:TADEPALLI, ASHA (OD)
Entity type:Individual
Prefix:DR
First Name:ASHA
Middle Name:
Last Name:TADEPALLI
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 1:3019 38TH STREET CT
Mailing Address - Street 2:
Mailing Address - City:MOLINE
Mailing Address - State:IL
Mailing Address - Zip Code:61265-7863
Mailing Address - Country:US
Mailing Address - Phone:309-236-8084
Mailing Address - Fax:
Practice Address - Street 1:1650 SELWYN AVENUE, SUITE 1C
Practice Address - Street 2:BRONXCARE HEALTH SYSTEM, DEPARTMENT OF OPHTHALMOLOGY
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10457
Practice Address - Country:US
Practice Address - Phone:718-960-2041
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-17
Last Update Date:2020-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV009128152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist