Provider Demographics
NPI:1336104330
Name:BATHIJA-LALA, BHARTI (OD)
Entity Type:Individual
Prefix:DR
First Name:BHARTI
Middle Name:
Last Name:BATHIJA-LALA
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 1:3830 WINDERMERE PKWY
Mailing Address - Street 2:SUITE 301
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30041
Mailing Address - Country:US
Mailing Address - Phone:770-887-1404
Mailing Address - Fax:
Practice Address - Street 1:3830 WINDERMERE PKWY
Practice Address - Street 2:SUITE 301
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30041
Practice Address - Country:US
Practice Address - Phone:770-887-1404
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-20
Last Update Date:2011-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV0069051152W00000X
GAOPT002328152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
V08114Medicare UPIN
C435B1Medicare ID - Type Unspecified