Provider Demographics
NPI:1235543687
Name:PATEL, PRAJAY (OD)
Entity type:Individual
Prefix:
First Name:PRAJAY
Middle Name:
Last Name:PATEL
Suffix:
Gender:
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1412 GREENBRIER PKWY STE 108A
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-2832
Mailing Address - Country:US
Mailing Address - Phone:757-424-0724
Mailing Address - Fax:
Practice Address - Street 1:29 W MAIN ST
Practice Address - Street 2:
Practice Address - City:HUMMELSTOWN
Practice Address - State:PA
Practice Address - Zip Code:17036-1538
Practice Address - Country:US
Practice Address - Phone:717-566-3216
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-13
Last Update Date:2025-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG002934152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1235543687OtherNPI