Provider Demographics
NPI:1942501572
Name:MISTRY, BHARAT R (DOCTOR OF OPTOMETRY)
Entity Type:Individual
Prefix:DR
First Name:BHARAT
Middle Name:R
Last Name:MISTRY
Suffix:
Gender:M
Credentials:DOCTOR OF OPTOMETRY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2211 HUDSON RD APT 120
Mailing Address - Street 2:
Mailing Address - City:GREER
Mailing Address - State:SC
Mailing Address - Zip Code:29650-5001
Mailing Address - Country:US
Mailing Address - Phone:617-910-8419
Mailing Address - Fax:
Practice Address - Street 1:617 HAYWOOD RD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29607-2744
Practice Address - Country:US
Practice Address - Phone:864-627-9500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-12
Last Update Date:2010-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1623152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist