Provider Demographics
NPI:1760612675
Name:GADANI, PRIYAL DILIPKUMAR (OD)
Entity Type:Individual
Prefix:
First Name:PRIYAL
Middle Name:DILIPKUMAR
Last Name:GADANI
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 1:1637 MOUNT VERNON RD STE 100
Mailing Address - Street 2:
Mailing Address - City:DUNWOODY
Mailing Address - State:GA
Mailing Address - Zip Code:30338-4262
Mailing Address - Country:US
Mailing Address - Phone:770-396-3460
Mailing Address - Fax:770-668-0436
Practice Address - Street 1:1637 MOUNT VERNON RD STE 100
Practice Address - Street 2:
Practice Address - City:DUNWOODY
Practice Address - State:GA
Practice Address - Zip Code:30338-4262
Practice Address - Country:US
Practice Address - Phone:770-396-3460
Practice Address - Fax:770-668-0436
Is Sole Proprietor?:No
Enumeration Date:2009-07-27
Last Update Date:2020-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA002578152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist