Provider Demographics
NPI:1306980339
Name:BHAKTA, NAINESH C (OD)
Entity type:Individual
Prefix:DR
First Name:NAINESH
Middle Name:C
Last Name:BHAKTA
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:721 E ELGIN ST
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85296-6581
Mailing Address - Country:US
Mailing Address - Phone:480-354-1093
Mailing Address - Fax:
Practice Address - Street 1:1365 S ALMA SCHOOL RD
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85210-2085
Practice Address - Country:US
Practice Address - Phone:480-615-9852
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2014-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1025152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ162079Medicare PIN
AZZ163010Medicare PIN