Provider Demographics
NPI:1497328736
Name:PATEL, HIMALI (OD)
Entity type:Individual
Prefix:
First Name:HIMALI
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 1:1621 HIGHWAY 15 N
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MS
Mailing Address - Zip Code:39440-2123
Mailing Address - Country:US
Mailing Address - Phone:601-518-3937
Mailing Address - Fax:601-518-0269
Practice Address - Street 1:1621 HIGHWAY 15 N
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MS
Practice Address - Zip Code:39440-2123
Practice Address - Country:US
Practice Address - Phone:601-518-3937
Practice Address - Fax:601-518-0269
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-23
Last Update Date:2024-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALS-E92-TA-C42152W00000X, 152W00000X
MS1055152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist