Provider Demographics
NPI:1750417028
Name:PATEL, PRAMESH (OD)
Entity type:Individual
Prefix:DR
First Name:PRAMESH
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 1:10659 GRAND AVE STE 5
Mailing Address - Street 2:
Mailing Address - City:SUN CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:85351-3427
Mailing Address - Country:US
Mailing Address - Phone:623-249-2781
Mailing Address - Fax:623-243-9694
Practice Address - Street 1:10659 GRAND AVE STE 5
Practice Address - Street 2:
Practice Address - City:SUN CITY
Practice Address - State:AZ
Practice Address - Zip Code:85351-3427
Practice Address - Country:US
Practice Address - Phone:623-249-2781
Practice Address - Fax:623-243-9694
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-23
Last Update Date:2021-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC3036152W00000X
AZ1554152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL620236500Medicaid
FLU64633Medicare UPIN
FL620236500Medicaid