Provider Demographics
NPI:1861264392
Name:PATEL, JEMI (OD)
Entity type:Individual
Prefix:DR
First Name:JEMI
Middle Name:
Last Name:PATEL
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8829 MARTIN WAY E APT 302
Mailing Address - Street 2:
Mailing Address - City:LACEY
Mailing Address - State:WA
Mailing Address - Zip Code:98516-6806
Mailing Address - Country:US
Mailing Address - Phone:201-519-2118
Mailing Address - Fax:
Practice Address - Street 1:9101 BRIDGEPORT WAY SW STE C
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98499-2419
Practice Address - Country:US
Practice Address - Phone:253-584-2020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-27
Last Update Date:2023-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOD61491209152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist