Healthcare Provider Details

I. General information

NPI: 1396576641
Provider Name (Legal Business Name): DISHA PATEL OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2024
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

850 WASHINGTON ST
MIDDLETOWN CT
06457-2912
US

IV. Provider business mailing address

5679 BLAKESLEE AVE
HARRISBURG PA
17111-4168
US

V. Phone/Fax

Practice location:
  • Phone: 978-208-2390
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number3.003481
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: