Provider Demographics
NPI:1801861604
Name:PATEL, NISHA (OD)
Entity Type:Individual
Prefix:
First Name:NISHA
Middle Name:
Last Name:PATEL
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2401 S STEMMONS FWY
Mailing Address - Street 2:SUITE 5000
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75067-8775
Mailing Address - Country:US
Mailing Address - Phone:972-459-4737
Mailing Address - Fax:972-315-5786
Practice Address - Street 1:2401 S STEMMONS FWY
Practice Address - Street 2:SUITE 5000
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75067-8775
Practice Address - Country:US
Practice Address - Phone:972-459-4737
Practice Address - Fax:972-315-5786
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-23
Last Update Date:2016-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6700TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist