Provider Demographics
NPI:1245206218
Name:GUPTA, NEEL KAMAL (OD)
Entity Type:Individual
Prefix:DR
First Name:NEEL
Middle Name:KAMAL
Last Name:GUPTA
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 1:19596 W 105TH TERRRACE
Mailing Address - Street 2:
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66061
Mailing Address - Country:US
Mailing Address - Phone:913-397-9146
Mailing Address - Fax:
Practice Address - Street 1:11801 W 95TH ST
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66214-1832
Practice Address - Country:US
Practice Address - Phone:913-599-4878
Practice Address - Fax:913-599-4878
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1704152W00000X
MO28643152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS651046Medicare ID - Type Unspecified