Provider Demographics
NPI:1629320205
Name:BAKHT, FATIMA SHIREEN (OD)
Entity Type:Individual
Prefix:DR
First Name:FATIMA
Middle Name:SHIREEN
Last Name:BAKHT
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2334 OAKLAND AVE
Mailing Address - Street 2:PEARLE VISION AT INDIANA MALL
Mailing Address - City:INDIANA
Mailing Address - State:PA
Mailing Address - Zip Code:15701-3348
Mailing Address - Country:US
Mailing Address - Phone:724-349-9580
Mailing Address - Fax:724-349-0611
Practice Address - Street 1:2334 OAKLAND AVE
Practice Address - Street 2:PEARLE VISION AT INDIANA MALL
Practice Address - City:INDIANA
Practice Address - State:PA
Practice Address - Zip Code:15701-3348
Practice Address - Country:US
Practice Address - Phone:724-349-9580
Practice Address - Fax:724-349-0611
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-08
Last Update Date:2012-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG002700152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist