Healthcare Provider Details

I. General information

NPI: 1134621089
Provider Name (Legal Business Name): PDP VISION, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2018
Last Update Date: 03/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

950 W TRENTON AVE UNIT 822
MORRISVILLE PA
19067-3717
US

IV. Provider business mailing address

950 W TRENTON AVE UNIT 822
MORRISVILLE PA
19067-3717
US

V. Phone/Fax

Practice location:
  • Phone: 704-819-2671
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: DR. PRIYA DESAI PATEL
Title or Position: OPTOMETRIST
Credential: OD
Phone: 704-819-2671