Provider Demographics
NPI:1447632443
Name:PATEL, PRIYA DESAI (OD)
Entity type:Individual
Prefix:DR
First Name:PRIYA
Middle Name:DESAI
Last Name:PATEL
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 1:950 W TRENTON AVE
Mailing Address - Street 2:#822
Mailing Address - City:MORRISVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19067-3633
Mailing Address - Country:US
Mailing Address - Phone:704-819-2671
Mailing Address - Fax:
Practice Address - Street 1:950 W TRENTON AVE
Practice Address - Street 2:#822
Practice Address - City:MORRISVILLE
Practice Address - State:PA
Practice Address - Zip Code:19067-3633
Practice Address - Country:US
Practice Address - Phone:704-819-2671
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-25
Last Update Date:2017-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG003240152W00000X
NJ27OA00670700152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist