Basic Information
| Provider Information | |||||||||
| NPI: | 1952605743 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PATHAK | ||||||||
| FirstName: | PRACHI | ||||||||
| MiddleName: | NILESH | ||||||||
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| Credential: | O. D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 885 S GOVERNORS AVE | ||||||||
| Address2: | |||||||||
| City: | DOVER | ||||||||
| State: | DE | ||||||||
| PostalCode: | 199044158 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3027345861 | ||||||||
| FaxNumber: | 3027341921 | ||||||||
| Practice Location | |||||||||
| Address1: | 885 S GOVERNORS AVE | ||||||||
| Address2: | |||||||||
| City: | DOVER | ||||||||
| State: | DE | ||||||||
| PostalCode: | 199044158 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3027345861 | ||||||||
| FaxNumber: | 3027341921 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/07/2011 | ||||||||
| LastUpdateDate: | 06/23/2011 | ||||||||
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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 | I3-0001350 | DE | Y | Eye and Vision Services Providers | Optometrist | 152W00000X | I4-0000054 | DE | N | Eye and Vision Services Providers | Optometrist |
ID Information
| ID | Type | State | Issuer | Description | G00016 | 01 | DE | HALPERN EYE ASSO GROUP MEDICARE | OTHER | 12186947 | 01 | CAQH | OTHER | 1346430360 | 01 | DE | HALPERN OPTHAMOLOGY ASSO GROUP NPI | OTHER | 803261H16 | 01 | MEDICARE PTAN HEA | OTHER | 803261H47 | 01 | MEDICARE PTAN HALPERN MEDICAL SERVICES | OTHER | G01047 | 01 | DE | HALPERN OPTHAMOLOGY ASSO GROUP MEDICARE ID | OTHER | I3-0001350 | 01 | DE | DE-PERMANENT LICENSE EFF 02072011 | OTHER | 1245251313 | 01 | DE | HALPERN EYE ASSOCIATES GROUP NPI | OTHER | 1952605743 | 01 | INDIVIUAL NPI | OTHER |