Provider Demographics
NPI:1871268052
Name:BADAL, RAJIV JAYANT (OD)
Entity Type:Individual
Prefix:
First Name:RAJIV
Middle Name:JAYANT
Last Name:BADAL
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 1:4414 SW COLLEGE RD UNIT 1462
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34474-2701
Mailing Address - Country:US
Mailing Address - Phone:352-622-5183
Mailing Address - Fax:
Practice Address - Street 1:4414 SW COLLEGE RD UNIT 1462
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34474-2701
Practice Address - Country:US
Practice Address - Phone:352-622-5183
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-10
Last Update Date:2022-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC5993152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist