Basic Information
| Provider Information | |||||||||
| NPI: | 1538356365 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BHAGA | ||||||||
| FirstName: | SHEETAL | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | O.D. | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 7638 STONEBROOK PKWY | ||||||||
| Address2: | |||||||||
| City: | FRISCO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750341003 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9727121010 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 7638 STONEBROOK PKWY | ||||||||
| Address2: | |||||||||
| City: | FRISCO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750341003 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9727121010 | ||||||||
| FaxNumber: | 9727121011 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/25/2007 | ||||||||
| LastUpdateDate: | 03/26/2021 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
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| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | Y | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 03/26/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 1597 | AZ | N | Eye and Vision Services Providers | Optometrist | 152W00000X | 7335TG | TX | Y | Eye and Vision Services Providers | Optometrist |
ID Information
| ID | Type | State | Issuer | Description | 1902852346 | 01 | TX | GROUP NPI | OTHER | 1538356365 | 01 | TX | NPI | OTHER | 84840Q | 01 | TX | BCBS | OTHER | 90168237 | 01 | TX | DPS | OTHER | 1234530001 | 01 | TX | DME PTAN | OTHER | MB1649752 | 01 | TX | DEA | OTHER | 11805172 | 01 | TX | CAQH | OTHER | 7335-TG | 01 | TX | LICENSE | OTHER | 00E41Y | 01 | TX | GROUP PTAN | OTHER |