Provider Demographics
NPI:1568873016
Name:BADRIA, KATHY (OD)
Entity Type:Individual
Prefix:MISS
First Name:KATHY
Middle Name:
Last Name:BADRIA
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 1:14456 W CARLIN DR
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85374-4227
Mailing Address - Country:US
Mailing Address - Phone:520-440-2834
Mailing Address - Fax:
Practice Address - Street 1:995 S COTTON LN
Practice Address - Street 2:
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85338-4604
Practice Address - Country:US
Practice Address - Phone:623-932-9359
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-17
Last Update Date:2014-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1964152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist