Organization
MOHINDER K. GUPTA, M.D., INC.
Active
Other names
Sugarbush Eye and Laser Centre
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MOHINDER K GUPTA M.D. (PRESIDENT)
(419) 289-6466
Entity
Organization
Contact information
Practice address
21 SUGARBUSH CT, ASHLAND, OH 44805-9737
(419) 289-6466
(419) 281-4067
Mailing address
21 SUGARBUSH CT, ASHLAND, OH 44805-9737
(419) 289-6466
(419) 281-4067
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
35041004
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0343711
—
OH
01
—
0460513
MEDICAID GROUP NUMBER
OH
05
—
2059561
—
OH
01
—
2322025
MEDICAID GROUP NUMBER
OH
05
—
2682726
—
OH
01
—
MO9287132
GROUP MEDICARE PIN
OH
Enumeration date
02/28/2007
Last updated
08/14/2008
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