Provider Demographics
NPI:1477853869
Name:DR. MANISH C. PATEL AND ASSOCIATES PA
Entity Type:Organization
Organization Name:DR. MANISH C. PATEL AND ASSOCIATES PA
Other - Org Name:DBA EYE ELEMENTS EYECARE ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OD OWNER/PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:MANISH
Authorized Official - Middle Name:C
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:904-716-5026
Mailing Address - Street 1:10915 BAYMEADOWS RD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-9130
Mailing Address - Country:US
Mailing Address - Phone:904-716-5026
Mailing Address - Fax:904-223-0088
Practice Address - Street 1:10915 BAYMEADOWS RD
Practice Address - Street 2:SUITE 110
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-9130
Practice Address - Country:US
Practice Address - Phone:904-716-5026
Practice Address - Fax:904-223-0088
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-01
Last Update Date:2011-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC3505152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPENDINGMedicaid