Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 1963 | NC |
N | 152WC0802X | Optomitrist - Corneal and Contact Lenses | 1963 | NC |
NPI | 1093763211 |
---|---|
Provider Name | Dr. Sanjay Bipin Patel |
First Address | Vienna, VA 22182-3990 |
Second Address | Apex, NC 27513 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/05/2006 |
Last Update Date | 09/11/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
093T3 | BCBS OF NC (01) | NC |
5902150 | (05) | NC |
U91924 | (02) | NC |