Provider Demographics
NPI:1508132986
Name:LAKE NONA OPHTHALMOLOGY PL
Entity Type:Organization
Organization Name:LAKE NONA OPHTHALMOLOGY PL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHIRAG
Authorized Official - Middle Name:JITENDRA
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:352-978-4896
Mailing Address - Street 1:6718 LAKE NONA BLVD STE 140
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32827-7984
Mailing Address - Country:US
Mailing Address - Phone:407-857-3937
Mailing Address - Fax:407-319-0420
Practice Address - Street 1:6718 LAKE NONA BLVD STE 140
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32827-7984
Practice Address - Country:US
Practice Address - Phone:407-857-3937
Practice Address - Fax:407-392-0420
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-29
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME111106207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty