Provider Demographics
NPI:1992216337
Name:PATEL, PURVI (OD)
Entity Type:Individual
Prefix:
First Name:PURVI
Middle Name:
Last Name:PATEL
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 1:220 CHAMPION DR
Mailing Address - Street 2:STE 100
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21740-6665
Mailing Address - Country:US
Mailing Address - Phone:301-791-0888
Mailing Address - Fax:
Practice Address - Street 1:400 N CENTER ST
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:MD
Practice Address - Zip Code:21157-5140
Practice Address - Country:US
Practice Address - Phone:410-751-6375
Practice Address - Fax:410-751-6729
Is Sole Proprietor?:No
Enumeration Date:2017-10-12
Last Update Date:2019-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDTA2607152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist