Provider Demographics
NPI:1780478461
Name:YAHDEV, MAHESH (LDO)
Entity type:Individual
Prefix:
First Name:MAHESH
Middle Name:
Last Name:YAHDEV
Suffix:
Gender:
Credentials:LDO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2912 EL DORADO AVE N
Mailing Address - Street 2:
Mailing Address - City:LAKE HAVASU CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86403-5314
Mailing Address - Country:US
Mailing Address - Phone:928-412-3854
Mailing Address - Fax:
Practice Address - Street 1:5695 HIGHWAY 95 N
Practice Address - Street 2:
Practice Address - City:LAKE HAVASU CITY
Practice Address - State:AZ
Practice Address - Zip Code:86404-9646
Practice Address - Country:US
Practice Address - Phone:928-764-3755
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-07
Last Update Date:2025-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLDO-003104156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician