Provider Demographics
NPI:1336134485
Name:BHAT, KESHAV (OD)
Entity Type:Individual
Prefix:DR
First Name:KESHAV
Middle Name:
Last Name:BHAT
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1013 CHESTNUT LN
Mailing Address - Street 2:SUITE 210
Mailing Address - City:MATTHEWS
Mailing Address - State:NC
Mailing Address - Zip Code:28104-8531
Mailing Address - Country:US
Mailing Address - Phone:704-821-5009
Mailing Address - Fax:866-334-0626
Practice Address - Street 1:1013 CHESTNUT LN
Practice Address - Street 2:SUITE 210
Practice Address - City:MATTHEWS
Practice Address - State:NC
Practice Address - Zip Code:28104-8531
Practice Address - Country:US
Practice Address - Phone:704-821-5009
Practice Address - Fax:866-334-0626
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-14
Last Update Date:2013-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1843152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2473133AMedicare PIN
NCU91777Medicare UPIN