Provider Demographics
NPI:1285772020
Name:GUPTA, SIMA LAL (OD, MPH)
Entity type:Individual
Prefix:
First Name:SIMA
Middle Name:LAL
Last Name:GUPTA
Suffix:
Gender:F
Credentials:OD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:860 PEACHTREE ST NE
Mailing Address - Street 2:SUITE F
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30308-1249
Mailing Address - Country:US
Mailing Address - Phone:404-853-5008
Mailing Address - Fax:
Practice Address - Street 1:860 PEACHTREE ST NE
Practice Address - Street 2:SUITE F
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30308-1249
Practice Address - Country:US
Practice Address - Phone:404-853-5008
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-02
Last Update Date:2011-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV007026152W00000X
GAOPT002472152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA6131590001Medicare NSC