Provider Demographics
NPI:1902264989
Name:FADEYI, BRENDA (OD)
Entity Type:Individual
Prefix:MRS
First Name:BRENDA
Middle Name:
Last Name:FADEYI
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:BRENDA
Other - Middle Name:
Other - Last Name:CASTRO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:650 S ZEDIKER AVE
Mailing Address - Street 2:BLDG 3
Mailing Address - City:PARLIER
Mailing Address - State:CA
Mailing Address - Zip Code:93648-2666
Mailing Address - Country:US
Mailing Address - Phone:559-646-6618
Mailing Address - Fax:559-876-6703
Practice Address - Street 1:1919 W. BUSINESS 83
Practice Address - Street 2:
Practice Address - City:WESLACO
Practice Address - State:TX
Practice Address - Zip Code:78596
Practice Address - Country:US
Practice Address - Phone:956-376-2003
Practice Address - Fax:559-846-5553
Is Sole Proprietor?:No
Enumeration Date:2016-02-04
Last Update Date:2019-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX92431152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist