Provider Demographics
NPI:1427496488
Name:PATEL, VIMAL SURESHCHANDRA (OD)
Entity type:Individual
Prefix:DR
First Name:VIMAL
Middle Name:SURESHCHANDRA
Last Name:PATEL
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
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Other - Middle Name:
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Mailing Address - Street 1:8614 WESTWOOD CENTER DR FL 9
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-2442
Mailing Address - Country:US
Mailing Address - Phone:703-847-8899
Mailing Address - Fax:
Practice Address - Street 1:10798 BELLEVILLE RD
Practice Address - Street 2:
Practice Address - City:VAN BUREN TWP
Practice Address - State:MI
Practice Address - Zip Code:48111-1308
Practice Address - Country:US
Practice Address - Phone:734-697-6671
Practice Address - Fax:734-697-9332
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-11
Last Update Date:2024-06-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4901004767152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist