Basic Information
| Provider Information | |||||||||
| NPI: | 1053690321 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BHATT | ||||||||
| FirstName: | SANIA | ||||||||
| MiddleName: | ANJUM | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | OD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | RANA | ||||||||
| OtherFirstName: | SANIA | ||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
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| OtherCredential: | OD | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 140 MACOMB PL | ||||||||
| Address2: | |||||||||
| City: | MOUNT CLEMENS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480435651 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5864641479 | ||||||||
| FaxNumber: | 5864641480 | ||||||||
| Practice Location | |||||||||
| Address1: | 8212 N LINDBERGH BLVD | ||||||||
| Address2: | |||||||||
| City: | FLORISSANT | ||||||||
| State: | MO | ||||||||
| PostalCode: | 630317107 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3148312221 | ||||||||
| FaxNumber: | 3148310199 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/04/2011 | ||||||||
| LastUpdateDate: | 10/28/2014 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 1860DT | KY | Y | Eye and Vision Services Providers | Optometrist |
No ID Information.