Provider Demographics
NPI:1588895700
Name:PATEL, DEVINA P (OD, FAAO)
Entity type:Individual
Prefix:DR
First Name:DEVINA
Middle Name:P
Last Name:PATEL
Suffix:
Gender:F
Credentials:OD, FAAO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1220 TAMARACK AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH WINDSOR
Mailing Address - State:CT
Mailing Address - Zip Code:06074-5572
Mailing Address - Country:US
Mailing Address - Phone:908-474-4046
Mailing Address - Fax:860-474-4045
Practice Address - Street 1:1220 TAMARACK AVENUE
Practice Address - Street 2:INDEPENDENT OPTOMETRIST INSIDE OF COSTCO
Practice Address - City:SOUTH WINDSOR
Practice Address - State:CT
Practice Address - Zip Code:06074-5572
Practice Address - Country:US
Practice Address - Phone:860-474-4046
Practice Address - Fax:860-474-4045
Is Sole Proprietor?:No
Enumeration Date:2009-08-05
Last Update Date:2022-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT2940152W00000X
NJ27OA00627100152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist