MEDICARE: DR. KESHAV BHAT O.D.

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	1843	NC

General Provider Information

NPI Number	:	1336134485
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KESHAV BHAT O.D.

Provider Business Mailing Address
First Line	:	1013 CHESTNUT LN
Second Line	:	SUITE 210
City	:	MATTHEWS
State	:	NC
Zip	:	28104-8531
Country	:	US
Telephone Number	:	704-821-5009
Fax Number	:	866-334-0626

Provider Business Practice Location Address
First Line	:	1013 CHESTNUT LN
Second Line	:	SUITE 210
City	:	MATTHEWS
State	:	NC
Zip	:	28104-8531
Country	:	US
Telephone Number	:	704-821-5009
Fax Number	:	866-334-0626

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

Provider Enumeration Date	:	09/14/2005
Last Update Date	:	09/27/2013

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