Provider Demographics
NPI:1952605743
Name:PATHAK, PRACHI NILESH (O D)
Entity Type:Individual
Prefix:
First Name:PRACHI
Middle Name:NILESH
Last Name:PATHAK
Suffix:
Gender:F
Credentials:O D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:885 S GOVERNORS AVE
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:DE
Mailing Address - Zip Code:19904-4158
Mailing Address - Country:US
Mailing Address - Phone:302-734-5861
Mailing Address - Fax:302-734-1921
Practice Address - Street 1:885 S GOVERNORS AVE
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19904-4158
Practice Address - Country:US
Practice Address - Phone:302-734-5861
Practice Address - Fax:302-734-1921
Is Sole Proprietor?:No
Enumeration Date:2011-01-07
Last Update Date:2011-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEI3-0001350152W00000X
DEI4-0000054152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DEG00016OtherHALPERN EYE ASSO GROUP MEDICARE
12186947OtherCAQH
DE1346430360OtherHALPERN OPTHAMOLOGY ASSO GROUP NPI
803261H16OtherMEDICARE PTAN HEA
803261H47OtherMEDICARE PTAN HALPERN MEDICAL SERVICES
DEG01047OtherHALPERN OPTHAMOLOGY ASSO GROUP MEDICARE ID
DEI3-0001350OtherDE-PERMANENT LICENSE EFF 02072011
DE1245251313OtherHALPERN EYE ASSOCIATES GROUP NPI
1952605743OtherINDIVIUAL NPI