Provider Demographics
NPI:1982835278
Name:PATEL, KRISHAN MAHESH (OD)
Entity Type:Individual
Prefix:
First Name:KRISHAN
Middle Name:MAHESH
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 1:2319 RAYFORD RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77386
Mailing Address - Country:US
Mailing Address - Phone:281-601-1001
Mailing Address - Fax:
Practice Address - Street 1:2319 RAYFORD RD
Practice Address - Street 2:SUITE 200
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77386
Practice Address - Country:US
Practice Address - Phone:281-601-1001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-04
Last Update Date:2013-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7446T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXB127478Medicare PIN