Provider Demographics
NPI:1952616930
Name:BHAKTA, RUPESH KIRAN (OD)
Entity Type:Individual
Prefix:DR
First Name:RUPESH
Middle Name:KIRAN
Last Name:BHAKTA
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 1:5307 DENMEADE DR NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30345-8003
Mailing Address - Country:US
Mailing Address - Phone:314-435-6584
Mailing Address - Fax:
Practice Address - Street 1:3331 HAMILTON MILL RD
Practice Address - Street 2:SUITE 1100
Practice Address - City:BUFORD
Practice Address - State:GA
Practice Address - Zip Code:30519-4096
Practice Address - Country:US
Practice Address - Phone:770-271-3500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-13
Last Update Date:2013-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT002539152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist