Provider Demographics
NPI:1659540755
Name:PATEL, VIBHABEN M (OD)
Entity Type:Individual
Prefix:DR
First Name:VIBHABEN
Middle Name:M
Last Name:PATEL
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:13803 LAUREL COLONY TRL
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77059-5014
Mailing Address - Country:US
Mailing Address - Phone:832-244-8118
Mailing Address - Fax:
Practice Address - Street 1:591 GULFGATE CENTER MALL
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77087
Practice Address - Country:US
Practice Address - Phone:832-244-8118
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-22
Last Update Date:2021-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7054T152W00000X
NJ27OA00610700152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ171552Medicare PIN