Provider Demographics
NPI:1477004729
Name:PATEL, TEJAS DILIP (OD)
Entity Type:Individual
Prefix:
First Name:TEJAS
Middle Name:DILIP
Last Name:PATEL
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16556 OLIVE HILL DR
Mailing Address - Street 2:
Mailing Address - City:WINTER GARDEN
Mailing Address - State:FL
Mailing Address - Zip Code:34787-9272
Mailing Address - Country:US
Mailing Address - Phone:352-406-9915
Mailing Address - Fax:
Practice Address - Street 1:16556 OLIVE HILL DR
Practice Address - Street 2:
Practice Address - City:WINTER GARDEN
Practice Address - State:FL
Practice Address - Zip Code:34787-9272
Practice Address - Country:US
Practice Address - Phone:352-406-9915
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-21
Last Update Date:2020-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC 5289152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist