Provider Demographics
NPI:1538252614
Name:GUPTA, RAHUL KUMAR (OD)
Entity type:Individual
Prefix:DR
First Name:RAHUL
Middle Name:KUMAR
Last Name:GUPTA
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1890 SAM RITTENBERG BLVD STE 107
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29407-4801
Mailing Address - Country:US
Mailing Address - Phone:843-763-2020
Mailing Address - Fax:843-763-2021
Practice Address - Street 1:1890 SAM RITTENBERG BLVD STE 107
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29407-4801
Practice Address - Country:US
Practice Address - Phone:843-763-2020
Practice Address - Fax:843-763-2021
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1376152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCD13679Medicaid