Basic Information
| Provider Information | |||||||||
| NPI: | 1194134668 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PATEL | ||||||||
| FirstName: | BHUMIKA | ||||||||
| MiddleName: | P | ||||||||
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| Credential: | OD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1569 HAZEL ST | ||||||||
| Address2: | |||||||||
| City: | TEGA CAY | ||||||||
| State: | SC | ||||||||
| PostalCode: | 29708 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2248489385 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1268 EBENEZER RD | ||||||||
| Address2: | |||||||||
| City: | ROCK HILL | ||||||||
| State: | SC | ||||||||
| PostalCode: | 297322341 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8038179755 | ||||||||
| FaxNumber: | 8033279843 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/08/2014 | ||||||||
| LastUpdateDate: | 05/30/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 1831 | SC | Y | Eye and Vision Services Providers | Optometrist |
No ID Information.