Provider Demographics
NPI:1467979476
Name:PATEL, ANISHA KYRINA MAHENDRA (OD)
Entity Type:Individual
Prefix:
First Name:ANISHA
Middle Name:KYRINA MAHENDRA
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 1:407 AVENUE K SE
Mailing Address - Street 2:
Mailing Address - City:WINTER HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33880-4126
Mailing Address - Country:US
Mailing Address - Phone:863-294-3504
Mailing Address - Fax:863-294-8305
Practice Address - Street 1:100 PATTERSON RD
Practice Address - Street 2:
Practice Address - City:HAINES CITY
Practice Address - State:FL
Practice Address - Zip Code:33844-7840
Practice Address - Country:US
Practice Address - Phone:863-422-4429
Practice Address - Fax:863-421-4280
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-30
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC5413152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist