Provider Demographics
NPI:1952702763
Name:BHAKTA SAMIR RAMESH OD PLLC
Entity Type:Organization
Organization Name:BHAKTA SAMIR RAMESH OD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
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:361-462-4484
Mailing Address - Street 1:2563 DIGGER LN
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78415-5346
Mailing Address - Country:US
Mailing Address - Phone:281-788-9748
Mailing Address - Fax:
Practice Address - Street 1:5488 S PADRE ISLAND DR STE 1308B
Practice Address - Street 2:DOCTOR'S OFFICE
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78411-4117
Practice Address - Country:US
Practice Address - Phone:281-788-9748
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-11
Last Update Date:2014-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty