Provider Demographics
NPI:1093898538
Name:PATEL, RACHANA ASHOK (MD)
Entity Type:Individual
Prefix:DR
First Name:RACHANA
Middle Name:ASHOK
Last Name:PATEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11945 SAN JOSE BLVD STE 300
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32223-1627
Mailing Address - Country:US
Mailing Address - Phone:904-396-1725
Mailing Address - Fax:904-396-4893
Practice Address - Street 1:13453 N MAIN ST STE 306
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32218-2774
Practice Address - Country:US
Practice Address - Phone:904-564-2020
Practice Address - Fax:904-683-3934
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-20
Last Update Date:2022-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME109933207W00000X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL14EH1OtherBCBSFL
FLFE075YOtherMEDICARE
FLP01389580OtherRAILROAD MEDICARE
RES000Medicare UPIN
FLFE075ZMedicare PIN