Provider Demographics
NPI:1376831990
Name:PATEL, CHIRAG K (OD)
Entity Type:Individual
Prefix:DR
First Name:CHIRAG
Middle Name:K
Last Name:PATEL
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:464 HILLSIDE AVE
Mailing Address - Street 2:SUITE #205
Mailing Address - City:NEEDHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02494-1227
Mailing Address - Country:US
Mailing Address - Phone:781-726-7337
Mailing Address - Fax:781-726-7310
Practice Address - Street 1:464 HILLSIDE AVE
Practice Address - Street 2:SUITE #205
Practice Address - City:NEEDHAM
Practice Address - State:MA
Practice Address - Zip Code:02494-1227
Practice Address - Country:US
Practice Address - Phone:781-726-7337
Practice Address - Fax:781-726-7310
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-17
Last Update Date:2014-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7826TG152W00000X, 152W00000X
MA5011152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX112409104Medicaid
TX112409104Medicaid