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General NPI Number Information
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NPI Number | 1679071286
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Entity Type | Organization
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Legal Business Name | SARIKA MEHTA OD PC
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Dates
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Enumeration Date | 01/29/2018
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Last Update Date | 01/29/2018
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Provider Practice Location Address
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Address Line | 16405 HILLSIDE AVE FL 2
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City | JAMAICA
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State | NY
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Zip | 11432-4140
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Country | US
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Telephone | 718-206-2893
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Fax | 718-206-2895
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Provider Business Mailing Address
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Address Line | 16405 HILLSIDE AVE FL 2
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City | JAMAICA
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State | NY
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Zip | 11432-4140
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. SARIKA MEHTA
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Credential | OD
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Telephone | 312-933-0799
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 007062-1
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License Number State | NY
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