Provider Demographics
NPI:1417187741
Name:MAREDIA, NAZIA N (OD)
Entity Type:Individual
Prefix:DR
First Name:NAZIA
Middle Name:N
Last Name:MAREDIA
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 1:1603 VANCE JACKSON RD
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78213-4470
Mailing Address - Country:US
Mailing Address - Phone:210-732-3200
Mailing Address - Fax:210-731-9089
Practice Address - Street 1:1603 VANCE JACKSON RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78213-4470
Practice Address - Country:US
Practice Address - Phone:210-732-3200
Practice Address - Fax:210-731-9089
Is Sole Proprietor?:No
Enumeration Date:2009-07-21
Last Update Date:2018-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7445TG152W00000X, 152WC0802X, 152WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152WP0200XEye and Vision Services ProvidersOptometristPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX283570401Medicaid
OH4268981Medicare PIN