Provider Demographics
NPI:1306214655
Name:GANDHI, RUCHI P (OD)
Entity Type:Individual
Prefix:DR
First Name:RUCHI
Middle Name:P
Last Name:GANDHI
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 1:646 S 8TH ST
Mailing Address - Street 2:
Mailing Address - City:GRIFFIN
Mailing Address - State:GA
Mailing Address - Zip Code:30224-4214
Mailing Address - Country:US
Mailing Address - Phone:770-228-3836
Mailing Address - Fax:770-412-1733
Practice Address - Street 1:646 8TH STREET
Practice Address - Street 2:
Practice Address - City:GRIFFIN
Practice Address - State:GA
Practice Address - Zip Code:30224
Practice Address - Country:US
Practice Address - Phone:770-228-3836
Practice Address - Fax:770-412-1733
Is Sole Proprietor?:No
Enumeration Date:2015-09-03
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALS-D36-TA-A31152W00000X
GAOPT002927152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003179560AMedicaid