Provider Demographics
NPI:1568635696
Name:RAHUL K. GUPTA
Entity Type:Organization
Organization Name:RAHUL K. GUPTA
Other - Org Name:EYES OF CHARLESTON, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DOCTOR OF OPTOMETRY
Authorized Official - Prefix:DR
Authorized Official - First Name:RAHUL
Authorized Official - Middle Name:KUMAR
Authorized Official - Last Name:GUPTA
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:843-763-2020
Mailing Address - Street 1:1890 SAM RITTENBERG BLVD STE 107
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29407-4801
Mailing Address - Country:US
Mailing Address - Phone:843-763-2020
Mailing Address - Fax:843-763-2021
Practice Address - Street 1:1890 SAM RITTENBERG BLVD STE 107
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29407-4801
Practice Address - Country:US
Practice Address - Phone:843-763-2020
Practice Address - Fax:843-763-2021
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-09
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1376152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCD13679Medicaid