Provider Demographics
NPI:1053780080
Name:PATEL, RIDHI (OD)
Entity type:Individual
Prefix:
First Name:RIDHI
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 1:8614 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:
Practice Address - Street 1:800 PEACHTREE ST NE STE E1
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30308-1252
Practice Address - Country:US
Practice Address - Phone:678-732-3432
Practice Address - Fax:678-732-3434
Is Sole Proprietor?:No
Enumeration Date:2015-09-21
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046010914152W00000X
GAOPT003485152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL7235044OtherAETNA
IL8825444OtherMULTIPLAN
IL0163706OtherBCBS
IL8825444OtherMULTIPLAN