Provider Demographics
NPI:1679692685
Name:KAISTHA, RUPAL PATEL (OD)
Entity type:Individual
Prefix:DR
First Name:RUPAL
Middle Name:PATEL
Last Name:KAISTHA
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:RUPAL
Other - Middle Name:PRAVIN
Other - Last Name:PATEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:42 HERON POINTE CT
Mailing Address - Street 2:
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-1778
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1032 CHERRY HILL MALL
Practice Address - Street 2:DR. DANIEL H. ISAAC, O.D., P.A. & ASSOC.
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08002-2100
Practice Address - Country:US
Practice Address - Phone:856-665-4111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA00596000152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0066095Medicaid
NJ090112Medicare ID - Type Unspecified
NJ0066095Medicaid