MEDICARE: SANIA ANJUM BHATT OD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	1860DT	KY

General Provider Information

NPI Number	:	1053690321
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SANIA ANJUM BHATT OD

Provider Business Mailing Address
First Line	:	140 MACOMB PL
Second Line	:
City	:	MOUNT CLEMENS
State	:	MI
Zip	:	48043-5651
Country	:	US
Telephone Number	:	586-464-1479
Fax Number	:	586-464-1480

Provider Business Practice Location Address
First Line	:	8212 N LINDBERGH BLVD
Second Line	:
City	:	FLORISSANT
State	:	MO
Zip	:	63031-7107
Country	:	US
Telephone Number	:	314-831-2221
Fax Number	:	314-831-0199

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/04/2011
Last Update Date	:	10/28/2014

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