Provider Demographics
NPI:1417322777
Name:BEDI, ANJLI J (OD)
Entity Type:Individual
Prefix:
First Name:ANJLI
Middle Name:J
Last Name:BEDI
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:ANJLI
Other - Middle Name:
Other - Last Name:JASROTIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12000 W CARMEN AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53225-2116
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2110 E. OKLAHOMA AVE
Practice Address - Street 2:SUITE B
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53207-2922
Practice Address - Country:US
Practice Address - Phone:414-747-9977
Practice Address - Fax:414-747-9988
Is Sole Proprietor?:No
Enumeration Date:2015-12-11
Last Update Date:2015-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3399-35152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist