Provider Demographics
NPI:1518645019
Name:DAYA, RADHI (OD)
Entity type:Individual
Prefix:
First Name:RADHI
Middle Name:
Last Name:DAYA
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 1:940 CHURCH RD W STE C
Mailing Address - Street 2:
Mailing Address - City:SOUTHAVEN
Mailing Address - State:MS
Mailing Address - Zip Code:38671-9611
Mailing Address - Country:US
Mailing Address - Phone:662-331-3937
Mailing Address - Fax:662-404-8884
Practice Address - Street 1:940 CHURCH RD W STE C
Practice Address - Street 2:
Practice Address - City:SOUTHAVEN
Practice Address - State:MS
Practice Address - Zip Code:38671-9611
Practice Address - Country:US
Practice Address - Phone:662-331-3937
Practice Address - Fax:662-404-8884
Is Sole Proprietor?:No
Enumeration Date:2023-07-06
Last Update Date:2024-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3820152W00000X
MS1080152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist