Provider Demographics
NPI:1518577147
Name:BHUVA, PRIYA (OD)
Entity type:Individual
Prefix:
First Name:PRIYA
Middle Name:
Last Name:BHUVA
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 FREEMONT ST
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:ONTARIO
Mailing Address - Zip Code:L4K 5J4
Mailing Address - Country:CA
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2421 VESTAL PKWY E STE 5
Practice Address - Street 2:
Practice Address - City:VESTAL
Practice Address - State:NY
Practice Address - Zip Code:13850-2066
Practice Address - Country:US
Practice Address - Phone:607-217-5169
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-07
Last Update Date:2020-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009225152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist