Provider Demographics
NPI:1033424437
Name:SPETH, ESLA SUBASHI (OD)
Entity Type:Individual
Prefix:DR
First Name:ESLA
Middle Name:SUBASHI
Last Name:SPETH
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:ESLA
Other - Middle Name:
Other - Last Name:SUBASHI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:1245 MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38104-2211
Mailing Address - Country:US
Mailing Address - Phone:901-722-3200
Mailing Address - Fax:
Practice Address - Street 1:1225 MADISON AVE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38104-2211
Practice Address - Country:US
Practice Address - Phone:901-722-3250
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-10
Last Update Date:2011-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2942152W00000X
OK2714152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist