Provider Demographics
NPI:1962690305
Name:DR. GUPTA, EYE M.D., LLC
Entity type:Organization
Organization Name:DR. GUPTA, EYE M.D., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:AJAY
Authorized Official - Middle Name:K
Authorized Official - Last Name:GUPTA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:440-260-0404
Mailing Address - Street 1:7255 OLD OAK BLVD.
Mailing Address - Street 2:C411
Mailing Address - City:MIDDLEBURG HTS.
Mailing Address - State:OH
Mailing Address - Zip Code:44130
Mailing Address - Country:US
Mailing Address - Phone:440-260-0404
Mailing Address - Fax:440-260-0401
Practice Address - Street 1:5319 HOAG DR
Practice Address - Street 2:SUTIE 260
Practice Address - City:SHEFFIELD VILLAGE
Practice Address - State:OH
Practice Address - Zip Code:44035-1494
Practice Address - Country:US
Practice Address - Phone:440-260-0404
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-11
Last Update Date:2010-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty