Provider Demographics
NPI:1578879839
Name:PATEL, KOMAL MANILAL (OD)
Entity Type:Individual
Prefix:
First Name:KOMAL
Middle Name:MANILAL
Last Name:PATEL
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2337 N PARK DR
Mailing Address - Street 2:SUITE 150
Mailing Address - City:HOLLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49424-8522
Mailing Address - Country:US
Mailing Address - Phone:616-510-2243
Mailing Address - Fax:616-510-2244
Practice Address - Street 1:3709 PLAINFIELD AVE NE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49525-2403
Practice Address - Country:US
Practice Address - Phone:616-365-2149
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-25
Last Update Date:2014-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901004607152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist