Provider Demographics
NPI:1528140605
Name:BABU, VASVI AMIN (OD)
Entity type:Individual
Prefix:DR
First Name:VASVI
Middle Name:AMIN
Last Name:BABU
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 1:307 E SOUTHERN AVE
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85282-5201
Mailing Address - Country:US
Mailing Address - Phone:480-816-0102
Mailing Address - Fax:480-287-5666
Practice Address - Street 1:307 E SOUTHERN AVE
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282
Practice Address - Country:US
Practice Address - Phone:480-967-5710
Practice Address - Fax:480-967-2845
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2016-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ905152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ35870601Medicaid
454665Medicare UPIN
AZ35870601Medicaid