Provider Demographics
NPI:1598441172
Name:TWEEDELL, CALLIA ANASTACIA (OD)
Entity Type:Individual
Prefix:
First Name:CALLIA
Middle Name:ANASTACIA
Last Name:TWEEDELL
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 1:489 RITCHIE HWY STE 200
Mailing Address - Street 2:
Mailing Address - City:SEVERNA PARK
Mailing Address - State:MD
Mailing Address - Zip Code:21146-2955
Mailing Address - Country:US
Mailing Address - Phone:410-975-0090
Mailing Address - Fax:
Practice Address - Street 1:489 RITCHIE HWY STE 200
Practice Address - Street 2:
Practice Address - City:SEVERNA PARK
Practice Address - State:MD
Practice Address - Zip Code:21146-2955
Practice Address - Country:US
Practice Address - Phone:410-975-0090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-27
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDTA2927152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist