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General NPI Number Information
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NPI Number | 1114690336
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Entity Type | Organization
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Legal Business Name | DR MONA PATEL OD LLC
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Dates
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Enumeration Date | 07/26/2021
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Last Update Date | 09/25/2025
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Provider Practice Location Address
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Address Line | 651 GRAND PANAMA BLVD # B1-105
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City | PANAMA CITY BEACH
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State | FL
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Zip | 32407-3458
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Country | US
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Telephone | 850-563-8800
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Fax | 859-563-8801
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Provider Business Mailing Address
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Address Line | 651 GRAND PANAMA BLVD STE 104
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City | PANAMA CITY
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State | FL
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Zip | 32407-3458
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Country | US
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Telephone | 850-563-8800
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Fax | 850-563-8801
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Authorized Official
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Title or Position | MANAGER
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Name | MONA PATEL
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Credential | OD
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Telephone | 312-890-3065
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number |
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License Number State |
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