Provider Demographics
NPI:1649400565
Name:BASS, ASHANTI (OD)
Entity type:Individual
Prefix:DR
First Name:ASHANTI
Middle Name:
Last Name:BASS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:ASHANTI
Other - Middle Name:EFFIE-MARIANNE
Other - Last Name:CARTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4055 RIDGE AVE
Mailing Address - Street 2:APT 1204
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19129-1576
Mailing Address - Country:US
Mailing Address - Phone:215-285-4686
Mailing Address - Fax:
Practice Address - Street 1:BLDG 1683 STARKEY AVE
Practice Address - Street 2:ANDREWS AIR FORCE BASE
Practice Address - City:ANDREWS AIRFORCE BASE
Practice Address - State:MD
Practice Address - Zip Code:20762
Practice Address - Country:US
Practice Address - Phone:301-735-1393
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-27
Last Update Date:2025-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG002701152W00000X
MDDA2491152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist