Provider Demographics
NPI:1710265582
Name:SAMIR BHAKTA, O.D., P.A.
Entity Type:Organization
Organization Name:SAMIR BHAKTA, O.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SAMIR
Authorized Official - Middle Name:
Authorized Official - Last Name:BHAKTA
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:361-854-2020
Mailing Address - Street 1:4109 S STAPLES ST
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78411-5500
Mailing Address - Country:US
Mailing Address - Phone:361-854-2020
Mailing Address - Fax:361-854-2021
Practice Address - Street 1:4109 S STAPLES ST
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78411-5500
Practice Address - Country:US
Practice Address - Phone:361-854-2020
Practice Address - Fax:361-854-2021
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-28
Last Update Date:2019-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1710265582OtherNPI
TXTXB139928OtherMEDICARE PTAN