Provider Demographics
NPI:1316181563
Name:SMIT A. PATEL O.D., AND IRENE GENDELMAN O.D., APOC
Entity Type:Organization
Organization Name:SMIT A. PATEL O.D., AND IRENE GENDELMAN O.D., APOC
Other - Org Name:SANTEE FAMILY OPTOMETRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:IRENE
Authorized Official - Middle Name:
Authorized Official - Last Name:GENDELMAN PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:O,D,
Authorized Official - Phone:858-405-9584
Mailing Address - Street 1:9349 MISSION GORGE RD
Mailing Address - Street 2:#114
Mailing Address - City:SANTEE
Mailing Address - State:CA
Mailing Address - Zip Code:92071-3886
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9349 MISSION GORGE RD
Practice Address - Street 2:#114
Practice Address - City:SANTEE
Practice Address - State:CA
Practice Address - Zip Code:92071-3886
Practice Address - Country:US
Practice Address - Phone:858-405-9484
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-30
Last Update Date:2015-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13305 T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CABW958AMedicare PIN