Provider Demographics
NPI:1811336548
Name:PATEL, BIMAL JAYPRAKASH (OD)
Entity type:Individual
Prefix:
First Name:BIMAL
Middle Name:JAYPRAKASH
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 1:1403 ELGIN ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77004-2832
Mailing Address - Country:US
Mailing Address - Phone:832-715-0974
Mailing Address - Fax:
Practice Address - Street 1:515 WESTHEIMER RD
Practice Address - Street 2:STE A-2
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77006-2931
Practice Address - Country:US
Practice Address - Phone:713-485-6033
Practice Address - Fax:713-497-5721
Is Sole Proprietor?:No
Enumeration Date:2013-06-15
Last Update Date:2016-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8171-T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00308VOtherGROUP MEDICARE PTAN
TX316040YKVCMedicare PIN
TX316040YM52Medicare PIN