Provider Demographics
NPI:1760715999
Name:PATHAK, ANJALI (OD)
Entity Type:Individual
Prefix:DR
First Name:ANJALI
Middle Name:
Last Name:PATHAK
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 1:10 FAXON AVE
Mailing Address - Street 2:114
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02169-4682
Mailing Address - Country:US
Mailing Address - Phone:857-540-6627
Mailing Address - Fax:
Practice Address - Street 1:10 FAXON AVE
Practice Address - Street 2:114
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02169-4682
Practice Address - Country:US
Practice Address - Phone:857-540-6627
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-04
Last Update Date:2009-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4763152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist