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NPI Code Detail

MEDICARE: SAIDIVYA KOMMA OD

MEDICARE: SAIDIVYA KOMMA OD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1152W00000XOptometrist2643NC
2390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1447888979
Entity Type Code : Individual
Provider Name (Legal Business Name) : SAIDIVYA KOMMA OD
Provider Business Mailing Address
First Line : 2415 REGENTS PARK LN
Second Line :
City : GREENSBORO
State : NC
Zip : 27455-1177
Country : US
Telephone Number : 336-809-3425
Fax Number :
Provider Business Practice Location Address
First Line : 1323 NEW GARDEN RD
Second Line :
City : GREENSBORO
State : NC
Zip : 27410-2722
Country : US
Telephone Number : 336-292-4516
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/30/2020
Last Update Date : 08/11/2023

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