Provider Demographics
NPI:1952955585
Name:PATEL, PUJA (OD)
Entity Type:Individual
Prefix:
First Name:PUJA
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 1:6422 E SPEEDWAY BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85710-1151
Mailing Address - Country:US
Mailing Address - Phone:520-325-9400
Mailing Address - Fax:520-325-8965
Practice Address - Street 1:6422 E SPEEDWAY BLVD STE 100
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85710-1151
Practice Address - Country:US
Practice Address - Phone:520-325-9400
Practice Address - Fax:520-325-8965
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-31
Last Update Date:2020-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618002811152W00000X
AZ002382152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist