Provider Demographics
NPI:1821345125
Name:KAKADE, ADITI (OD)
Entity Type:Individual
Prefix:
First Name:ADITI
Middle Name:
Last Name:KAKADE
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:PO BOX 1054
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98057-1054
Mailing Address - Country:US
Mailing Address - Phone:404-277-6221
Mailing Address - Fax:
Practice Address - Street 1:1135 LAKE WASHINGTON BLVD N
Practice Address - Street 2:UNIT G401
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98056-4815
Practice Address - Country:US
Practice Address - Phone:404-277-6221
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-06
Last Update Date:2016-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT002709152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILP01244061OtherRAILROAD MEDICARE
ILIL7059009Medicare PIN
ILIL7061009Medicare PIN
ILIL7060009Medicare PIN
ILP01244061OtherRAILROAD MEDICARE