Provider Demographics
NPI:1598931669
Name:YERRAMILLI, DURGA (OD)
Entity Type:Individual
Prefix:DR
First Name:DURGA
Middle Name:
Last Name:YERRAMILLI
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1515 N LITCHFIELD RD
Mailing Address - Street 2:
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85395-1237
Mailing Address - Country:US
Mailing Address - Phone:623-536-2439
Mailing Address - Fax:623-536-2441
Practice Address - Street 1:1515 N LITCHFIELD RD
Practice Address - Street 2:
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85395
Practice Address - Country:US
Practice Address - Phone:623-536-2439
Practice Address - Fax:623-536-2441
Is Sole Proprietor?:No
Enumeration Date:2008-05-07
Last Update Date:2018-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1618152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist