Provider Demographics
NPI:1740396852
Name:SHILPA B. PATEL, PA
Entity Type:Organization
Organization Name:SHILPA B. PATEL, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:SHILPA
Authorized Official - Middle Name:B
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:512-218-4567
Mailing Address - Street 1:2423 WILLIAMS DR STE 113
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78628-3269
Mailing Address - Country:US
Mailing Address - Phone:180-087-7527
Mailing Address - Fax:512-864-2668
Practice Address - Street 1:1205 ROUND ROCK AVE STE 102
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78681-4516
Practice Address - Country:US
Practice Address - Phone:512-388-2337
Practice Address - Fax:512-399-7965
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-22
Last Update Date:2014-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6610TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXVO9045Medicare UPIN