Provider Demographics
NPI:1053690321
Name:BHATT, SANIA ANJUM (OD)
Entity Type:Individual
Prefix:
First Name:SANIA
Middle Name:ANJUM
Last Name:BHATT
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:SANIA
Other - Middle Name:
Other - Last Name:RANA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:140 MACOMB PL
Mailing Address - Street 2:
Mailing Address - City:MOUNT CLEMENS
Mailing Address - State:MI
Mailing Address - Zip Code:48043-5651
Mailing Address - Country:US
Mailing Address - Phone:586-464-1479
Mailing Address - Fax:586-464-1480
Practice Address - Street 1:8212 N LINDBERGH BLVD
Practice Address - Street 2:
Practice Address - City:FLORISSANT
Practice Address - State:MO
Practice Address - Zip Code:63031-7107
Practice Address - Country:US
Practice Address - Phone:314-831-2221
Practice Address - Fax:314-831-0199
Is Sole Proprietor?:No
Enumeration Date:2011-08-04
Last Update Date:2014-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1860DT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOMA2445Medicare PIN