Provider Demographics
NPI:1598916041
Name:RESULI, ENEIDA (OD)
Entity Type:Individual
Prefix:
First Name:ENEIDA
Middle Name:
Last Name:RESULI
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:ENEIDA
Other - Middle Name:
Other - Last Name:HAFEZI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:211 E BROADWAY
Mailing Address - Street 2:
Mailing Address - City:ALTON
Mailing Address - State:IL
Mailing Address - Zip Code:62002-6220
Mailing Address - Country:US
Mailing Address - Phone:618-462-9818
Mailing Address - Fax:314-741-4947
Practice Address - Street 1:427 LAFAYETTE CTR
Practice Address - Street 2:
Practice Address - City:BALLWIN
Practice Address - State:MO
Practice Address - Zip Code:63011-3943
Practice Address - Country:US
Practice Address - Phone:636-391-1309
Practice Address - Fax:636-394-4892
Is Sole Proprietor?:No
Enumeration Date:2008-10-02
Last Update Date:2012-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2008019621152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist