Provider Demographics
NPI:1053543652
Name:PATEL, PRIYA (OD)
Entity type:Individual
Prefix:DR
First Name:PRIYA
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 1:82 EMERALD RDG
Mailing Address - Street 2:
Mailing Address - City:AIKEN
Mailing Address - State:SC
Mailing Address - Zip Code:29803-8417
Mailing Address - Country:US
Mailing Address - Phone:803-443-4444
Mailing Address - Fax:
Practice Address - Street 1:3553 RICHLAND AVE W
Practice Address - Street 2:SUITE 136
Practice Address - City:AIKEN
Practice Address - State:SC
Practice Address - Zip Code:29801-3089
Practice Address - Country:US
Practice Address - Phone:803-641-4646
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-14
Last Update Date:2012-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1564152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA666756257AMedicaid
SCD15641Medicaid
GA202I413437Medicare PIN