Provider Demographics
NPI:1134474299
Name:VESAMIA, YASMIN (OD)
Entity Type:Individual
Prefix:DR
First Name:YASMIN
Middle Name:
Last Name:VESAMIA
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 1:8480 LIMEKILN PIKE
Mailing Address - Street 2:APARTMENT 320
Mailing Address - City:WYNCOTE
Mailing Address - State:PA
Mailing Address - Zip Code:19095-2801
Mailing Address - Country:US
Mailing Address - Phone:407-443-8056
Mailing Address - Fax:
Practice Address - Street 1:2118 COTTMAN AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19149-1133
Practice Address - Country:US
Practice Address - Phone:215-725-1209
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-16
Last Update Date:2012-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG002611152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist