Provider Demographics
NPI:1790027910
Name:BHAVESH PATEL OD PLLC
Entity Type:Organization
Organization Name:BHAVESH PATEL OD PLLC
Other - Org Name:TEXAS STATE OPTICAL KELLER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BHAVESHKUMAR
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:512-791-9560
Mailing Address - Street 1:12584 N BEACH ST
Mailing Address - Street 2:SUITE 122
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76244-4249
Mailing Address - Country:US
Mailing Address - Phone:817-431-4100
Mailing Address - Fax:
Practice Address - Street 1:12584 N BEACH ST
Practice Address - Street 2:SUITE 122
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76244-4249
Practice Address - Country:US
Practice Address - Phone:817-431-4100
Practice Address - Fax:855-490-5723
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-26
Last Update Date:2013-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7124TG152W00000X, 152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX290451Medicare PIN