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General NPI Number Information
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NPI Number | 1790205672
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Entity Type | Individual
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Provider Name | VIXITKUMAR PATEL OD
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Gender | Male
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Dates
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Enumeration Date | 06/22/2017
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Last Update Date | 09/10/2019
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Provider Practice Location Address
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Address Line | 3264 BUFORD DR STE 100A
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City | BUFORD
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State | GA
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Zip | 30519-8743
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Country | US
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Telephone | 678-395-2020
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Fax |
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Provider Business Mailing Address
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Address Line | 300B STERLING CT
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City | STATESBORO
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State | GA
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Zip | 30458-9026
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Country | US
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Telephone | 912-656-9264
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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 | OPT003019
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License Number State | GA
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