MEDICARE: VIRAL MANUBHAI PATEL O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1689021636
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VIRAL MANUBHAI PATEL O.D.

Provider Business Mailing Address
First Line	:	2995 EASTROCK DR
Second Line	:
City	:	ROCKFORD
State	:	IL
Zip	:	61109-1737
Country	:	US
Telephone Number	:	815-226-1500
Fax Number	:	815-484-9307

Provider Business Practice Location Address
First Line	:	2995 EASTROCK DR
Second Line	:
City	:	ROCKFORD
State	:	IL
Zip	:	61109-1737
Country	:	US
Telephone Number	:	815-226-1500
Fax Number	:	815-484-9307

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/19/2016
Last Update Date	:	05/19/2016

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