Healthcare Provider Details

I. General information

NPI: 1487585329
Provider Name (Legal Business Name): PRATYUSH DHAKAL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2026
Last Update Date: 06/05/2026
Certification Date: 06/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7640 MEADOW STREAM LOOP STE 303
CHATTANOOGA TN
37421-7931
US

IV. Provider business mailing address

7640 MEADOW STREAM LOOP STE 303
CHATTANOOGA TN
37421-7931
US

V. Phone/Fax

Practice location:
  • Phone: 331-312-2021
  • Fax:
Mailing address:
  • Phone: 331-312-2021
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code156FX1100X
TaxonomyOphthalmic Technician/Technologist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: