Provider Demographics
NPI:1457551459
Name:BHAKTA, SAMIR (OD)
Entity type:Individual
Prefix:
First Name:SAMIR
Middle Name:
Last Name:BHAKTA
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:4109 S STAPLES ST
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78411-5500
Mailing Address - Country:US
Mailing Address - Phone:361-854-2020
Mailing Address - Fax:361-854-2021
Practice Address - Street 1:4109 S STAPLES ST
Practice Address - Street 2:AT THE NEW PARKDALE SUPERCENTER
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78411-5500
Practice Address - Country:US
Practice Address - Phone:361-854-2020
Practice Address - Fax:361-854-2021
Is Sole Proprietor?:No
Enumeration Date:2007-07-19
Last Update Date:2025-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7056TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist