Healthcare Provider Details

I. General information

NPI: 1235543687
Provider Name (Legal Business Name): PRAJAY PATEL OD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/13/2014
Last Update Date: 07/25/2026
Certification Date: 07/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1412 GREENBRIER PKWY STE 108A
CHESAPEAKE VA
23320-2832
US

IV. Provider business mailing address

1412 GREENBRIER PKWY STE 108A
CHESAPEAKE VA
23320-2832
US

V. Phone/Fax

Practice location:
  • Phone: 757-424-3135
  • Fax:
Mailing address:
  • Phone: 757-424-0724
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOEG002934
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: