Provider Demographics
NPI:1962855437
Name:PATEL, TANIA (OD)
Entity Type:Individual
Prefix:DR
First Name:TANIA
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 1:408 CHELSEA WOODS DR
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40509-1478
Mailing Address - Country:US
Mailing Address - Phone:954-830-0100
Mailing Address - Fax:
Practice Address - Street 1:2353 ALEXANDRIA DR
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40504
Practice Address - Country:US
Practice Address - Phone:859-224-2655
Practice Address - Fax:859-223-7147
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-19
Last Update Date:2018-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC 5190152W00000X
KY2032DT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist