Provider Demographics
NPI:1487088944
Name:PATEL, JANAKKUMAR VIJAYKUMAR (OD)
Entity type:Individual
Prefix:DR
First Name:JANAKKUMAR
Middle Name:VIJAYKUMAR
Last Name:PATEL
Suffix:
Gender:M
Credentials:OD
Other - Prefix:DR
Other - First Name:JAY
Other - Middle Name:V
Other - Last Name:PATEL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:111 JOHN AVE SE
Mailing Address - Street 2:
Mailing Address - City:ATTALLA
Mailing Address - State:AL
Mailing Address - Zip Code:35954-3464
Mailing Address - Country:US
Mailing Address - Phone:256-458-8118
Mailing Address - Fax:
Practice Address - Street 1:973 GILBERT FERRY RD SE
Practice Address - Street 2:
Practice Address - City:ATTALLA
Practice Address - State:AL
Practice Address - Zip Code:35954-3339
Practice Address - Country:US
Practice Address - Phone:256-538-7902
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-02
Last Update Date:2013-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALS-D16-TA-964152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist