Basic Information
| Provider Information | |||||||||
| NPI: | 1528370152 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PATEL | ||||||||
| FirstName: | MALLIKA | ||||||||
| MiddleName: | S | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | O.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3015 NICOSH CIR | ||||||||
| Address2: | UNIT #2403 | ||||||||
| City: | FALLS CHURCH | ||||||||
| State: | VA | ||||||||
| PostalCode: | 220421235 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5402506674 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 4301 WISCONSIN AVE NW | ||||||||
| Address2: | |||||||||
| City: | WASHINGTON | ||||||||
| State: | DC | ||||||||
| PostalCode: | 200162160 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2022378500 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/12/2010 | ||||||||
| LastUpdateDate: | 06/03/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/03/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | TA2213 | MD | N | Eye and Vision Services Providers | Optometrist | 152W00000X | 0618001972 | VA | N | Eye and Vision Services Providers | Optometrist | 152W00000X | OP1000202 | DC | Y | Eye and Vision Services Providers | Optometrist |
No ID Information.