Provider Demographics
NPI:1346318383
Name:PATEL, MANISH K (OD)
Entity Type:Individual
Prefix:DR
First Name:MANISH
Middle Name:K
Last Name:PATEL
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:5353 W HIGHWAY 290
Mailing Address - Street 2:SUITE 102
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78735-0045
Mailing Address - Country:US
Mailing Address - Phone:512-899-2020
Mailing Address - Fax:512-899-3295
Practice Address - Street 1:5353 W HIGHWAY 290
Practice Address - Street 2:SUITE 102
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78735-0045
Practice Address - Country:US
Practice Address - Phone:512-899-2020
Practice Address - Fax:512-899-3295
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2016-05-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX05814TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8F2380Medicare ID - Type Unspecified
TXU78076Medicare UPIN