Provider Demographics
NPI:1710154570
Name:BHASKARAN, SHEEBA (OD)
Entity Type:Individual
Prefix:DR
First Name:SHEEBA
Middle Name:
Last Name:BHASKARAN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7252 FRANKFORD AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19135-1017
Mailing Address - Country:US
Mailing Address - Phone:215-335-3555
Mailing Address - Fax:215-335-3540
Practice Address - Street 1:7252 FRANKFORD AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19135-1017
Practice Address - Country:US
Practice Address - Phone:215-335-3555
Practice Address - Fax:215-335-3540
Is Sole Proprietor?:No
Enumeration Date:2008-05-12
Last Update Date:2008-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOET009058152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001430122006Medicaid
PA119462Medicare PIN
PA001430122006Medicaid