Provider Demographics
NPI:1437189701
Name:BHAVNANI, VINOD (MD)
Entity Type:Individual
Prefix:
First Name:VINOD
Middle Name:
Last Name:BHAVNANI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6810 PORTO FINO CIR
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33912-7140
Mailing Address - Country:US
Mailing Address - Phone:239-437-8118
Mailing Address - Fax:239-437-8119
Practice Address - Street 1:6810 PORTO FINO CIR
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33912-7140
Practice Address - Country:US
Practice Address - Phone:239-437-8118
Practice Address - Fax:239-437-8119
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2011-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME70739207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL37343ZMedicare PIN
180034629Medicare PIN
G37783Medicare UPIN
FL32343AMedicare PIN