Healthcare Provider Details

I. General information

NPI: 1194134668
Provider Name (Legal Business Name): BHUMIKA P PATEL OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2014
Last Update Date: 05/30/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1268 EBENEZER RD
ROCK HILL SC
29732-2341
US

IV. Provider business mailing address

1569 HAZEL ST
TEGA CAY SC
29708
US

V. Phone/Fax

Practice location:
  • Phone: 803-817-9755
  • Fax: 803-327-9843
Mailing address:
  • Phone: 224-848-9385
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1831
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: