Provider Demographics
NPI:1225237142
Name:PATEL, DIPAK C (OD)
Entity Type:Individual
Prefix:DR
First Name:DIPAK
Middle Name:C
Last Name:PATEL
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2036 PLAZA DR
Mailing Address - Street 2:
Mailing Address - City:WEST COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91790-2842
Mailing Address - Country:US
Mailing Address - Phone:626-960-5537
Mailing Address - Fax:626-960-5357
Practice Address - Street 1:2036 PLAZA DR
Practice Address - Street 2:
Practice Address - City:WEST COVINA
Practice Address - State:CA
Practice Address - Zip Code:91790-2842
Practice Address - Country:US
Practice Address - Phone:626-960-5537
Practice Address - Fax:626-960-5357
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-11
Last Update Date:2007-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9333 TPA152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist