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General NPI Number Information
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NPI Number | 1689975476
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Entity Type | Organization
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Legal Business Name | THE CHANDRASI EYE GROUP, LLC
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Dates
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Enumeration Date | 11/10/2010
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Last Update Date | 11/10/2010
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Provider Practice Location Address
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Address Line | 6555 E SOUTHERN AVE SUITE A22
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City | MESA
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State | AZ
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Zip | 85206-3718
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Country | US
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Telephone | 602-492-2016
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Fax | 480-302-5267
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Provider Business Mailing Address
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Address Line | 721 E ELGIN ST
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City | GILBERT
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State | AZ
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Zip | 85295-1581
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Country | US
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Telephone | 602-315-5201
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Fax | 480-302-5267
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Authorized Official
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Title or Position | PRESIDENT/OPTOMETRIST
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Name | DR. NAINESH C BHAKTA
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Credential | O.D.
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Telephone | 602-315-5201
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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 | 1025
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License Number State | AZ
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