Healthcare Provider Details

I. General information

NPI: 1386211563
Provider Name (Legal Business Name): MOHIT BATRA OD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2021
Last Update Date: 01/05/2022
Certification Date: 01/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1224 OSTRANDER AVE
RIVERHEAD NY
11901-2109
US

IV. Provider business mailing address

1224 OSTRANDER AVE
RIVERHEAD NY
11901-2109
US

V. Phone/Fax

Practice location:
  • Phone: 631-727-2858
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number009393
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: