Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 1047 | SC |
NPI | 1003870890 |
---|---|
Provider Name | Dr. Mohamed Shabir Bharadia |
First Address | Columbia, SC 29221-1203 |
Second Address | Columbia, SC 29210-6804 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/04/2006 |
Last Update Date | 25/04/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D10478 | (05) | SC |
U29011 | (02) | SC |