Active NPI
Mohamed Shabir Bharadia, OD
- Optometrist
- Columbia, SC
National Provider Identifier
1003870890
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 1047
- Practice address
- 1326 Bush River Rd
At Walmart Vision Center
Columbia, SC 29210-6804 - Phone
- (803) 750-4949
- Fax
- (803) 750-7172
- NPI assigned
- Apr 17, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 1047 | SC | Primary |
Addresses
Primary practice location
1326 Bush River Rd
At Walmart Vision Center
Columbia, SC 29210-6804
Mailing address
PO Box 21203
Columbia, SC 29221-1203
Phone (803) 750-4949
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| D10478 | Medicaid | SC |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1047 | SC | MD | Registered Dietitian |
Networks
- KY PPO C-SNP
- KY PPO
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1145232000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1209081600000",
"number": "1003870890",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 21203",
"city": "COLUMBIA",
"state": "SC",
"postal_code": "292211203",
"telephone_number": "803-750-4949",
"fax_number": "803-750-7172"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1326 BUSH RIVER RD",
"address_2": "AT WALMART VISION CENTER",
"city": "COLUMBIA",
"state": "SC",
"postal_code": "292106804",
"telephone_number": "803-750-4949",
"fax_number": "803-750-7172"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BHARADIA",
"first_name": "MOHAMED",
"middle_name": "SHABIR",
"name_prefix": "Dr.",
"credential": "OD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-04-17",
"last_updated": "2008-04-25",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "SC",
"license": "1047",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "D10478",
"state": "SC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Columbia, SC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 25, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.