Provider Demographics
NPI:1962012609
Name:PATEL, AYEESHA (OD)
Entity Type:Individual
Prefix:DR
First Name:AYEESHA
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 1:2680 N ORANGE AVE APT 1338
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32804-4733
Mailing Address - Country:US
Mailing Address - Phone:407-923-5191
Mailing Address - Fax:
Practice Address - Street 1:3062 DYER BLVD
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-7839
Practice Address - Country:US
Practice Address - Phone:407-343-6228
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-07
Last Update Date:2023-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009219152W00000X
FLOPC6021152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist