Provider Demographics
NPI:1508133588
Name:PATEL, VISHAL SANJAY (OD)
Entity Type:Individual
Prefix:DR
First Name:VISHAL
Middle Name:SANJAY
Last Name:PATEL
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:201 KIMBERLY WAY
Mailing Address - Street 2:SUITE 106
Mailing Address - City:CANTON
Mailing Address - State:GA
Mailing Address - Zip Code:30114-8008
Mailing Address - Country:US
Mailing Address - Phone:678-381-2020
Mailing Address - Fax:678-381-2015
Practice Address - Street 1:201 KIMBERLY WAY
Practice Address - Street 2:SUITE 106
Practice Address - City:CANTON
Practice Address - State:GA
Practice Address - Zip Code:30114-8008
Practice Address - Country:US
Practice Address - Phone:678-381-2020
Practice Address - Fax:678-381-2015
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-19
Last Update Date:2014-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT002647152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist