MEDICARE: NIMALI S PATEL OD

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	152W00000X	Optometrist	4430	MA

General Provider Information

NPI Number	:	1710906284
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NIMALI S PATEL OD

Provider Business Mailing Address
First Line	:	6 WHITTIER PL
Second Line	:	APT 16B
City	:	BOSTON
State	:	MA
Zip	:	02114-1443
Country	:	US
Telephone Number	:	973-207-3369
Fax Number	:

Provider Business Practice Location Address
First Line	:	165 CAMBRIDGE ST
Second Line	:
City	:	BOSTON
State	:	MA
Zip	:	02114-2783
Country	:	US
Telephone Number	:	617-367-2462
Fax Number	:	617-367-2462

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

Provider Enumeration Date	:	07/18/2006
Last Update Date	:	07/08/2007

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