Provider Demographics
NPI:1114690336
Name:DR MONA PATEL OD LLC
Entity type:Organization
Organization Name:DR MONA PATEL OD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MONA
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:312-890-3065
Mailing Address - Street 1:651 GRAND PANAMA BLVD STE 104
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32407-3458
Mailing Address - Country:US
Mailing Address - Phone:850-563-8800
Mailing Address - Fax:850-563-8801
Practice Address - Street 1:651 GRAND PANAMA BLVD # B1-105
Practice Address - Street 2:
Practice Address - City:PANAMA CITY BEACH
Practice Address - State:FL
Practice Address - Zip Code:32407-3458
Practice Address - Country:US
Practice Address - Phone:850-563-8800
Practice Address - Fax:859-563-8801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-26
Last Update Date:2025-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty