Organization
LOUISVILLE RETINA PLLC
Active
Organization
LOUISVILLE RETINA PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANUPA MANDAVA MD (MD)
(718) 300-1540
Entity
Organization
Contact information
Practice address
1169 EASTERN PKWY STE 3323, LOUISVILLE, KY 40217-1415
(718) 300-1540
Mailing address
1169 EASTERN PKWY STE 3323, LOUISVILLE, KY 40217-1415
(502) 873-0900
(502) 873-0950
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7100779210
—
KY
Enumeration date
10/26/2021
Last updated
02/03/2022
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