Provider Demographics
NPI:1407729767
Name:PHATAK, SOHAM (OD)
Entity type:Individual
Prefix:
First Name:SOHAM
Middle Name:
Last Name:PHATAK
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7547 WATERSIDE LOOP RD STE A
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:NC
Mailing Address - Zip Code:28037-7678
Mailing Address - Country:US
Mailing Address - Phone:704-822-9920
Mailing Address - Fax:
Practice Address - Street 1:3849 TERRELL PARK DR.
Practice Address - Street 2:SUITE 100
Practice Address - City:SHERRILLS FORD
Practice Address - State:NC
Practice Address - Zip Code:28673
Practice Address - Country:US
Practice Address - Phone:704-270-4740
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-24
Last Update Date:2025-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2889152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist