Provider Demographics
NPI:1558737023
Name:PARASURAM, GEETHA (OD)
Entity Type:Individual
Prefix:
First Name:GEETHA
Middle Name:
Last Name:PARASURAM
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 1:220 N MCKEMY AVE
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85226-2654
Mailing Address - Country:US
Mailing Address - Phone:480-961-1865
Mailing Address - Fax:480-961-8938
Practice Address - Street 1:775 E FLORENCE BLVD
Practice Address - Street 2:#2
Practice Address - City:CASA GRANDE
Practice Address - State:AZ
Practice Address - Zip Code:85122
Practice Address - Country:US
Practice Address - Phone:520-426-1600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-19
Last Update Date:2015-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2081152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ179893OtherMEDICARE PTAN
AZZ179895OtherMEDICARE PTAN
AZZ179891OtherMEDICARE PTAN
AZZ179892OtherMEDICARE PTAN
AZZ179896OtherMEDICARE PTAN
AZZ179894OtherMEDICARE PTAN