Provider Demographics
NPI:1598315640
Name:PATEL, SONAM K (OD)
Entity Type:Individual
Prefix:
First Name:SONAM
Middle Name:K
Last Name:PATEL
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 1:180 W GIRARD AVE STE 5
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19123-1660
Mailing Address - Country:US
Mailing Address - Phone:215-554-6222
Mailing Address - Fax:215-554-6200
Practice Address - Street 1:180 W GIRARD AVE STE 5
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19123-1660
Practice Address - Country:US
Practice Address - Phone:215-554-6222
Practice Address - Fax:215-554-6200
Is Sole Proprietor?:No
Enumeration Date:2019-09-19
Last Update Date:2021-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA00690600152W00000X
NJ27OM00158200156F00000X
PAOEG003737152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No156F00000XEye and Vision Services ProvidersTechnician/Technologist