Provider Demographics
NPI:1689975476
Name:THE CHANDRASI EYE GROUP, LLC
Entity Type:Organization
Organization Name:THE CHANDRASI EYE GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:NAINESH
Authorized Official - Middle Name:C
Authorized Official - Last Name:BHAKTA
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:602-315-5201
Mailing Address - Street 1:721 E ELGIN ST
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85295-1581
Mailing Address - Country:US
Mailing Address - Phone:602-315-5201
Mailing Address - Fax:480-302-5267
Practice Address - Street 1:6555 E SOUTHERN AVE
Practice Address - Street 2:SUITE A22
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-3718
Practice Address - Country:US
Practice Address - Phone:602-492-2016
Practice Address - Fax:480-302-5267
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-10
Last Update Date:2010-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1025152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty