Provider Demographics
NPI:1063165108
Name:PATEL, JANESSA (OD)
Entity type:Individual
Prefix:DR
First Name:JANESSA
Middle Name:
Last Name:PATEL
Suffix:
Gender:
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11512 LAKE MEAD AVE UNIT 534
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-5835
Mailing Address - Country:US
Mailing Address - Phone:904-564-2020
Mailing Address - Fax:
Practice Address - Street 1:11512 LAKE MEAD AVE UNIT 534
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-5835
Practice Address - Country:US
Practice Address - Phone:904-564-2020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-29
Last Update Date:2025-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA5529152W00000X
FL6362152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist