MEDICARE: PUJA PATEL O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	21299-875	WI
2	152W00000X	Optometrist	046-010801	IL
3	152W00000X	Optometrist	TPOP59	FL
4	152W00000X	Optometrist	3752-35	WI
5	152W00000X	Optometrist	OPT002862	GA

General Provider Information

NPI Number	:	1174936876
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PUJA PATEL O.D.

Provider Business Mailing Address
First Line	:	2300 WHITEOAK DR SE
Second Line	:
City	:	SMYRNA
State	:	GA
Zip	:	30080-7422
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3330 PIEDMONT RD NE
Second Line	:	SUITE 1
City	:	ATLANTA
State	:	GA
Zip	:	30305-1726
Country	:	US
Telephone Number	:	404-231-3772
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/10/2014
Last Update Date	:	03/06/2023

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Directions to “ PUJA PATEL O.D.” Practice Location

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