Healthcare Provider Details

I. General information

NPI: 1366014151
Provider Name (Legal Business Name): MONA MILAN PATEL OD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/12/2021
Last Update Date: 07/12/2021
Certification Date: 07/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4671 S UNIVERSITY DR
DAVIE FL
33328
US

IV. Provider business mailing address

4928 TANYA LEE CIRCLE APT #7208
DAVIE FL
33328
US

V. Phone/Fax

Practice location:
  • Phone: 954-434-4671
  • Fax:
Mailing address:
  • Phone: 407-810-9452
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPC5965
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: