Provider Demographics
NPI:1669458972
Name:LACORTE, NEHA AMIN (OD)
Entity Type:Individual
Prefix:DR
First Name:NEHA
Middle Name:AMIN
Last Name:LACORTE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:NEHA
Other - Middle Name:AMIN
Other - Last Name:LACORTE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3404 W CHERYL DR
Mailing Address - Street 2:SUITE 180
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85051-9578
Mailing Address - Country:US
Mailing Address - Phone:602-863-2223
Mailing Address - Fax:602-863-0156
Practice Address - Street 1:3404 W CHERYL DR STE 180
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85051-9500
Practice Address - Country:US
Practice Address - Phone:602-863-2223
Practice Address - Fax:602-863-0156
Is Sole Proprietor?:No
Enumeration Date:2005-12-19
Last Update Date:2010-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1037152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0903170OtherBLUE CROSS BLUE SHIELD
AZ491407Medicaid
AZ491407Medicaid
AZAZ0903170OtherBLUE CROSS BLUE SHIELD