Individual
ANISA R PATAIL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OD
Contact information
Practice address
407 AVENUE K SE, WINTER HAVEN, FL 33880-4126
(863) 294-3504
Mailing address
407 AVENUE K SE, WINTER HAVEN, FL 33880-4126
(863) 294-3504
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
OPC5987
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
OPC5987
STATE LICENSE
—
Enumeration date
08/04/2021
Last updated
08/04/2021
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