Provider Demographics
NPI:1679291207
Name:PATEL, KOSHA
Entity type:Individual
Prefix:DR
First Name:KOSHA
Middle Name:
Last Name:PATEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:763 EASTVIEW MALL SPC 160
Mailing Address - Street 2:
Mailing Address - City:VICTOR
Mailing Address - State:NY
Mailing Address - Zip Code:14564-1032
Mailing Address - Country:US
Mailing Address - Phone:585-425-7400
Mailing Address - Fax:
Practice Address - Street 1:763 EASTVIEW MALL SPC 160
Practice Address - Street 2:
Practice Address - City:VICTOR
Practice Address - State:NY
Practice Address - Zip Code:14564-1032
Practice Address - Country:US
Practice Address - Phone:585-425-7400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-19
Last Update Date:2022-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009645152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist