Healthcare Provider Details

I. General information

NPI: 1265673156
Provider Name (Legal Business Name): DEVAL ACHIT PATEL O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2009
Last Update Date: 03/22/2022
Certification Date: 03/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2233 E GARVEY AVE N STE A
WEST COVINA CA
91791-1500
US

IV. Provider business mailing address

2225 E GARVEY AVE N
WEST COVINA CA
91791-1500
US

V. Phone/Fax

Practice location:
  • Phone: 626-600-9486
  • Fax: 951-813-4044
Mailing address:
  • Phone: 626-600-9486
  • Fax: 951-813-4044

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License NumberCA125256
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: