Provider Demographics
NPI:1861603136
Name:YEDULAPURAM, BHAVANI (OD)
Entity type:Individual
Prefix:DR
First Name:BHAVANI
Middle Name:
Last Name:YEDULAPURAM
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 1:2403 S STEMMONS FWY STE 113
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75067-2314
Mailing Address - Country:US
Mailing Address - Phone:972-315-6500
Mailing Address - Fax:214-488-4949
Practice Address - Street 1:2403 S STEMMONS FWY STE 113
Practice Address - Street 2:
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75067-2314
Practice Address - Country:US
Practice Address - Phone:972-315-6500
Practice Address - Fax:214-488-4949
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6666T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist