=====================================================
General NPI Number Information
=====================================================
NPI Number | 1528560315
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ENFOCUS, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/07/2018
-----------------------------------------------------
Last Update Date | 03/07/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 950 W TRENTON AVE UNIT 1072
-----------------------------------------------------
City | MORRISVILLE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19067-3731
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 267-380-0126
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 950 W TRENTON AVE UNIT 1072
-----------------------------------------------------
City | MORRISVILLE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19067-3731
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 267-380-0126
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OPTOMETRIST
-----------------------------------------------------
Name | DR. PRIYA DESAI PATEL
-----------------------------------------------------
Credential | OD
-----------------------------------------------------
Telephone | 704-819-2671
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------