Provider Demographics
NPI:1780626747
Name:PATEL, PARESH A (OD)
Entity type:Individual
Prefix:DR
First Name:PARESH
Middle Name:A
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 1:1007A SKYWAY DR
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:NC
Mailing Address - Zip Code:28110-3042
Mailing Address - Country:US
Mailing Address - Phone:704-289-1547
Mailing Address - Fax:704-291-9441
Practice Address - Street 1:1007A SKYWAY DR
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:NC
Practice Address - Zip Code:28110-3042
Practice Address - Country:US
Practice Address - Phone:704-289-1547
Practice Address - Fax:704-291-9441
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2008-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1739152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89093MAMedicaid
NC093MAOtherBCBSNC PIN
NC093MAOtherBCBSNC PIN
NCP00183297Medicare PIN
NC2222468CMedicare PIN