MEDICARE: BHAVIKA MAHESH PATIDAR 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	3015	TN

General Provider Information

NPI Number	:	1891075727
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BHAVIKA MAHESH PATIDAR O.D.

Provider Business Mailing Address
First Line	:	232 MAPLE SPRINGS DR
Second Line	:
City	:	MANCHESTER
State	:	TN
Zip	:	37355-3764
Country	:	US
Telephone Number	:	859-233-4511
Fax Number	:

Provider Business Practice Location Address
First Line	:	232 MAPLE SPRINGS DR
Second Line	:
City	:	MANCHESTER
State	:	TN
Zip	:	37355-3764
Country	:	US
Telephone Number	:	859-233-4511
Fax Number	:

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

Provider Enumeration Date	:	08/23/2011
Last Update Date	:	07/26/2012

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