Provider Demographics
NPI:1609398809
Name:PATEL, PRITESH S (OD)
Entity Type:Individual
Prefix:
First Name:PRITESH
Middle Name:S
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 1:2510 BIENVILLE BLVD
Mailing Address - Street 2:
Mailing Address - City:OCEAN SPRINGS
Mailing Address - State:MS
Mailing Address - Zip Code:39564-3117
Mailing Address - Country:US
Mailing Address - Phone:228-875-3318
Mailing Address - Fax:228-875-3398
Practice Address - Street 1:2510 BIENVILLE BLVD
Practice Address - Street 2:
Practice Address - City:OCEAN SPRINGS
Practice Address - State:MS
Practice Address - Zip Code:39564
Practice Address - Country:US
Practice Address - Phone:228-875-3318
Practice Address - Fax:228-875-3398
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-10
Last Update Date:2018-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS961152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist