Provider Demographics
NPI:1154492718
Name:RAMAMURTHY, MAHA (OD, MS)
Entity Type:Individual
Prefix:DR
First Name:MAHA
Middle Name:
Last Name:RAMAMURTHY
Suffix:
Gender:F
Credentials:OD, MS
Other - Prefix:
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Other - Last Name:
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Mailing Address - Street 1:67 WELLS RD
Mailing Address - Street 2:
Mailing Address - City:WETHERSFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06109-3043
Mailing Address - Country:US
Mailing Address - Phone:860-529-5429
Mailing Address - Fax:860-563-5202
Practice Address - Street 1:67 WELLS RD
Practice Address - Street 2:
Practice Address - City:WETHERSFIELD
Practice Address - State:CT
Practice Address - Zip Code:06109-3043
Practice Address - Country:US
Practice Address - Phone:860-529-5429
Practice Address - Fax:860-563-5202
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTCT2672152W00000X
CT2672152WC0802X, 152WL0500X, 152WP0200X, 152WS0006X, 152WV0400X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152WL0500XEye and Vision Services ProvidersOptometristLow Vision Rehabilitation
No152WP0200XEye and Vision Services ProvidersOptometristPediatrics
No152WS0006XEye and Vision Services ProvidersOptometristSports Vision
No152WV0400XEye and Vision Services ProvidersOptometristVision Therapy