Provider Demographics
NPI:1801144753
Name:PATEL, JIGNA DILIPKUMAR (OD)
Entity type:Individual
Prefix:
First Name:JIGNA
Middle Name:DILIPKUMAR
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 1:8614 WESTWOOD CENTER DR FL 9
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-2442
Mailing Address - Country:US
Mailing Address - Phone:703-847-8899
Mailing Address - Fax:571-223-6780
Practice Address - Street 1:11761 US 70 BUSINESS HWY W STE 25
Practice Address - Street 2:
Practice Address - City:CLAYTON
Practice Address - State:NC
Practice Address - Zip Code:27520-2274
Practice Address - Country:US
Practice Address - Phone:919-553-5600
Practice Address - Fax:919-879-2684
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-27
Last Update Date:2024-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2298152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
175KROtherBCBS
NCNC9293LMedicare PIN
NCNC9293GMedicare PIN
NCNC9293HMedicare PIN
175KROtherBCBS
NCNC9293AMedicare PIN
NCNC9293FMedicare PIN
NCNC9293BMedicare PIN
NCNC9293CMedicare PIN
NCNC9293DMedicare PIN
NCNC9293IMedicare PIN
NCNC9293JMedicare PIN
NCNC9293KMedicare PIN