=====================================================
General NPI Number Information
=====================================================
NPI Number | 1457967804
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NIRMALA VISION PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/21/2020
-----------------------------------------------------
Last Update Date | 11/15/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 999 N TUSTIN AVE STE 219
-----------------------------------------------------
City | SANTA ANA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92705-6506
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-541-4185
-----------------------------------------------------
Fax | 714-541-3465
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 999 N TUSTIN AVE STE 219
-----------------------------------------------------
City | SANTA ANA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92705-6506
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-541-4185
-----------------------------------------------------
Fax | 714-541-3465
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHYSICIAN
-----------------------------------------------------
Name | ANAND BIPIN BHATT
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 863-835-1689
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207WX0009X
-----------------------------------------------------
Taxonomy Name | Glaucoma Specialist (Ophthalmology) Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------