Provider Demographics
NPI:1316080013
Name:BHADRA, NEPA (OD)
Entity type:Individual
Prefix:
First Name:NEPA
Middle Name:
Last Name:BHADRA
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5236 MCGINNIS FERRY RD
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30005-3921
Mailing Address - Country:US
Mailing Address - Phone:678-297-7575
Mailing Address - Fax:678-297-7564
Practice Address - Street 1:5236 MCGINNIS FERRY RD
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30005-3921
Practice Address - Country:US
Practice Address - Phone:678-297-7575
Practice Address - Fax:678-297-7564
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-14
Last Update Date:2010-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT001524152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAV11200Medicare UPIN
GA41ZCGGJMedicare PIN