Provider Demographics
NPI:1659752657
Name:BERA, RADHIKA PATEL (OD)
Entity type:Individual
Prefix:
First Name:RADHIKA
Middle Name:PATEL
Last Name:BERA
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:RADHIKA
Other - Middle Name:
Other - Last Name:PATEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:2661 RIVA RD STE 1030
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-7131
Mailing Address - Country:US
Mailing Address - Phone:410-571-8733
Mailing Address - Fax:410-571-6309
Practice Address - Street 1:711 LAWN AVE STE 3
Practice Address - Street 2:
Practice Address - City:SELLERSVILLE
Practice Address - State:PA
Practice Address - Zip Code:18960-1575
Practice Address - Country:US
Practice Address - Phone:215-257-8053
Practice Address - Fax:215-257-2020
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-15
Last Update Date:2025-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG003040152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist