Provider Demographics
NPI:1548342058
Name:PATEL, RAJIV (OD)
Entity type:Individual
Prefix:DR
First Name:RAJIV
Middle Name:
Last Name:PATEL
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:314 E MCLOUGHLIN BLVD
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98663-3387
Mailing Address - Country:US
Mailing Address - Phone:360-694-8303
Mailing Address - Fax:360-694-9032
Practice Address - Street 1:314 E MCLOUGHLIN BLVD
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98663-3387
Practice Address - Country:US
Practice Address - Phone:360-694-8303
Practice Address - Fax:360-694-9032
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2016-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA00003396152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA024356009OtherREGENCE
WA126091OtherDEPT. OF LABOR AND IND.
WA410039503OtherRR MEDICARE
WA2022226Medicaid
WA212766OtherEYE MED
WA126091OtherDEPT. OF LABOR AND IND.
WA410039503OtherRR MEDICARE