Provider Demographics
NPI:1801022686
Name:MEHTA, RONAK (OD)
Entity Type:Individual
Prefix:DR
First Name:RONAK
Middle Name:
Last Name:MEHTA
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 1:8358 MONTGOMERY RUN RD
Mailing Address - Street 2:UNIT H
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21043-7286
Mailing Address - Country:US
Mailing Address - Phone:443-629-1192
Mailing Address - Fax:
Practice Address - Street 1:8358 MONTGOMERY RUN RD
Practice Address - Street 2:UNIT H
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21043-7286
Practice Address - Country:US
Practice Address - Phone:443-629-1192
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-07
Last Update Date:2010-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDTA2156152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist