Healthcare Provider Details

I. General information

NPI: 1053396887
Provider Name (Legal Business Name): NIDHI GUPTA SATIANI OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NIDHI S GUPTA OD

II. Dates (important events)

Enumeration Date: 12/14/2005
Last Update Date: 03/25/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 W 10TH AVE
COLUMBUS OH
43210-1280
US

IV. Provider business mailing address

2357 HETTER ST
COLUMBUS OH
43228-9017
US

V. Phone/Fax

Practice location:
  • Phone: 614-292-5859
  • Fax: 614-247-8627
Mailing address:
  • Phone: 614-487-1266
  • Fax: 614-247-8627

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number5552
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: