Provider Demographics
NPI:1609211853
Name:PATEL, DIVIYESH BHAGVANJI (OD)
Entity Type:Individual
Prefix:DR
First Name:DIVIYESH
Middle Name:BHAGVANJI
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 1:22995 HIGHWAY 76 E
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:SC
Mailing Address - Zip Code:29325-7529
Mailing Address - Country:US
Mailing Address - Phone:864-833-0038
Mailing Address - Fax:864-833-0520
Practice Address - Street 1:22995 HIGHWAY 76 E
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:SC
Practice Address - Zip Code:29325-7529
Practice Address - Country:US
Practice Address - Phone:864-833-0038
Practice Address - Fax:864-833-0520
Is Sole Proprietor?:No
Enumeration Date:2013-05-01
Last Update Date:2016-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1749152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist