Provider Demographics
NPI:1710407465
Name:PATEL, MITUL MAHESH (OD)
Entity Type:Individual
Prefix:DR
First Name:MITUL
Middle Name:MAHESH
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 1:2620 HURLEY WAY
Mailing Address - Street 2:STE A
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95864-3789
Mailing Address - Country:US
Mailing Address - Phone:916-753-3007
Mailing Address - Fax:
Practice Address - Street 1:2620 HURLEY WAY
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95864-3789
Practice Address - Country:US
Practice Address - Phone:916-453-1111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-23
Last Update Date:2017-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT33675-TLG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist