Provider Demographics
NPI:1194796516
Name:YADAV, RICHA (OD)
Entity type:Individual
Prefix:DR
First Name:RICHA
Middle Name:
Last Name:YADAV
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 1:5001 FRANKFORD AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19124-2619
Mailing Address - Country:US
Mailing Address - Phone:215-288-5000
Mailing Address - Fax:215-744-1233
Practice Address - Street 1:5001 FRANKFORD AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19124-2619
Practice Address - Country:US
Practice Address - Phone:215-288-5000
Practice Address - Fax:215-744-1233
Is Sole Proprietor?:No
Enumeration Date:2006-02-01
Last Update Date:2010-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG001731152W00000X
NJOA00598800152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA3Y6217OtherHEALTH NET
NJ0097772Medicaid
NJ2675838000OtherAMERIHEALTH
PA1018079890001Medicaid
NJ1821135OtherHIGHMARK BS
PA097246Medicare PIN
NJ100078Medicare PIN
NJ2675838000OtherAMERIHEALTH