Provider Demographics
NPI:1407973134
Name:PATEL, RITA N (OD)
Entity Type:Individual
Prefix:
First Name:RITA
Middle Name:N
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 1:811 W. ROYAL LANE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75039
Mailing Address - Country:US
Mailing Address - Phone:214-393-3008
Mailing Address - Fax:214-393-3009
Practice Address - Street 1:811 W ROYAL LN STE 100
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75039-4302
Practice Address - Country:US
Practice Address - Phone:214-393-3008
Practice Address - Fax:214-393-3009
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2022-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6669T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXV03694Medicare UPIN
TX8D1710Medicare ID - Type Unspecified