Provider Demographics
NPI:1528891876
Name:LOVE, VEDA
Entity type:Individual
Prefix:
First Name:VEDA
Middle Name:
Last Name:LOVE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:VEDA
Other - Middle Name:
Other - Last Name:TRIBBLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5412 SAPPHIRE SPRINGS DR
Mailing Address - Street 2:
Mailing Address - City:KNIGHTDALE
Mailing Address - State:NC
Mailing Address - Zip Code:27545-7591
Mailing Address - Country:US
Mailing Address - Phone:612-875-3220
Mailing Address - Fax:
Practice Address - Street 1:5412 SAPPHIRE SPRINGS DR
Practice Address - Street 2:
Practice Address - City:KNIGHTDALE
Practice Address - State:NC
Practice Address - Zip Code:27545-7591
Practice Address - Country:US
Practice Address - Phone:612-875-3220
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-22
Last Update Date:2024-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNQ2C9K4Y6156F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156F00000XEye and Vision Services ProvidersTechnician/Technologist