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General NPI Number Information
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NPI Number | 1326396938
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Entity Type | Individual
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Provider Name | NISHA J PATEL O.D.
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Gender | Female
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Dates
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Enumeration Date | 08/29/2012
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Last Update Date | 09/24/2021
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Provider Practice Location Address
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Address Line | 2427 MAIN STREET EAST
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City | SNELLVILLE
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State | GA
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Zip | 30078
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Country | US
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Telephone | 770-978-2020
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 207173
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City | DALLAS
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State | TX
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Zip | 75320-7173
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 8092T
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 002796
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License Number State | GA
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