Provider Demographics
NPI:1841298973
Name:PATEL, DIPAK T (OD)
Entity type:Individual
Prefix:DR
First Name:DIPAK
Middle Name:T
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 1:2930 PRESTON RD
Mailing Address - Street 2:SUITE 905
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034-9053
Mailing Address - Country:US
Mailing Address - Phone:972-334-9095
Mailing Address - Fax:972-334-0614
Practice Address - Street 1:2930 PRESTON RD
Practice Address - Street 2:SUITE 905
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-9053
Practice Address - Country:US
Practice Address - Phone:972-334-9095
Practice Address - Fax:972-334-0614
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5944T152W00000X, 152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered152W00000XEye and Vision Services ProvidersOptometrist
Not Answered152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
00202PMedicare ID - Type Unspecified
U85173Medicare UPIN