Provider Demographics
NPI:1902836547
Name:PATEL, KIRTESH (OD)
Entity Type:Individual
Prefix:DR
First Name:KIRTESH
Middle Name:
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 1:7926 BISHOP RD
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75024-4016
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:214-703-0898
Practice Address - Street 1:5150 N GARLAND AVE
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75040-2711
Practice Address - Country:US
Practice Address - Phone:214-703-0898
Practice Address - Fax:214-703-0898
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2010-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG001524152W00000X
TX07022TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX613721Medicare PIN