Basic Information
| Provider Information | |||||||||
| NPI: | 1699184721 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MEHTA | ||||||||
| FirstName: | GAURI | ||||||||
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| Credential: | O.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 55 WATER STREET | ||||||||
| Address2: | 2ND FLOOR CRED DEPT | ||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100410004 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6466802888 | ||||||||
| FaxNumber: | 5165425556 | ||||||||
| Practice Location | |||||||||
| Address1: | 226 CLINTON STREET | ||||||||
| Address2: | |||||||||
| City: | HEMPSTEAD | ||||||||
| State: | NY | ||||||||
| PostalCode: | 11550 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5164832020 | ||||||||
| FaxNumber: | 5165601855 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/02/2014 | ||||||||
| LastUpdateDate: | 09/20/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152WL0500X | 14965TLG | CA | N | Eye and Vision Services Providers | Optometrist | Low Vision Rehabilitation | 152W00000X | 14965TLG | CA | Y | Eye and Vision Services Providers | Optometrist |
No ID Information.