Provider Demographics
NPI:1043525215
Name:PATEL, RIKTI M (OD)
Entity type:Individual
Prefix:MISS
First Name:RIKTI
Middle Name:M
Last Name:PATEL
Suffix:
Gender:F
Credentials:OD
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Mailing Address - Street 1:1950 OLD GALLOWS RD STE 520
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-3970
Mailing Address - Country:US
Mailing Address - Phone:703-847-8899
Mailing Address - Fax:866-795-4020
Practice Address - Street 1:1418 DRESDEN DR NE
Practice Address - Street 2:
Practice Address - City:BROOKHAVEN
Practice Address - State:GA
Practice Address - Zip Code:30319-3598
Practice Address - Country:US
Practice Address - Phone:404-239-0272
Practice Address - Fax:404-239-0298
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-12
Last Update Date:2018-03-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GAOPT002604152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist