Provider Demographics
NPI:1851588172
Name:MEHTA, NISHA PANJWANI (OD)
Entity Type:Individual
Prefix:
First Name:NISHA
Middle Name:PANJWANI
Last Name:MEHTA
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 1:2531 E LYON STATION RD
Mailing Address - Street 2:SUITE F
Mailing Address - City:CREEDMOOR
Mailing Address - State:NC
Mailing Address - Zip Code:27522-9401
Mailing Address - Country:US
Mailing Address - Phone:919-734-2273
Mailing Address - Fax:
Practice Address - Street 1:2531 E LYON STATION RD
Practice Address - Street 2:SUITE F
Practice Address - City:CREEDMOOR
Practice Address - State:NC
Practice Address - Zip Code:27522-9401
Practice Address - Country:US
Practice Address - Phone:919-734-2273
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-01
Last Update Date:2016-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2051152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5908326Medicaid
NC093W8OtherBCBS
NC2473137Medicare PIN