Provider Demographics
NPI:1912039579
Name:PATEL, JITESH KANTILAL (OD)
Entity Type:Individual
Prefix:DR
First Name:JITESH
Middle Name:KANTILAL
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:P.O. BOX 79124
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77024
Mailing Address - Country:US
Mailing Address - Phone:281-300-1447
Mailing Address - Fax:
Practice Address - Street 1:248 MEMORIAL CITY WAY
Practice Address - Street 2:STE B
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77024-2588
Practice Address - Country:US
Practice Address - Phone:346-395-5563
Practice Address - Fax:346-395-5566
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-09
Last Update Date:2021-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6791TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist