Provider Demographics
NPI:1407377674
Name:AMIN, AVANI PATEL (OD)
Entity Type:Individual
Prefix:
First Name:AVANI
Middle Name:PATEL
Last Name:AMIN
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 1:1502 W CHESTER PIKE STE 15
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19382-7705
Mailing Address - Country:US
Mailing Address - Phone:610-708-5575
Mailing Address - Fax:
Practice Address - Street 1:1502 W CHESTER PIKE STE 15
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19382-7705
Practice Address - Country:US
Practice Address - Phone:610-708-5575
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG003430152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist