Provider Demographics
NPI:1831313808
Name:PATEL, AVANI J (OD)
Entity Type:Individual
Prefix:DR
First Name:AVANI
Middle Name:J
Last Name:PATEL
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:10900 LOS ALAMITOS BLVD
Mailing Address - Street 2:STE 102
Mailing Address - City:LOS ALAMITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90720
Mailing Address - Country:US
Mailing Address - Phone:562-430-6161
Mailing Address - Fax:562-598-3041
Practice Address - Street 1:10900 LOS ALAMITOS BLVD
Practice Address - Street 2:STE 102
Practice Address - City:LOS ALAMITOS
Practice Address - State:CA
Practice Address - Zip Code:90720
Practice Address - Country:US
Practice Address - Phone:562-430-6161
Practice Address - Fax:562-598-3041
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2007-10-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA10548T152W00000X, 152WL0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WL0500XEye and Vision Services ProvidersOptometristLow Vision Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
U58919Medicare UPIN
CAOP10548TMedicare PIN