MEDICARE: DR. NISHA PATEL O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	OPC4269	FL
2	152W00000X	Optometrist	OEG001942	PA
3	152W00000X	Optometrist	2097	NC

General Provider Information

NPI Number	:	1447450531
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NISHA PATEL O.D.

Provider Business Mailing Address
First Line	:	1001 E WT HARRIS BLVD
Second Line	:	SUITE T
City	:	CHARLOTTE
State	:	NC
Zip	:	28213-4104
Country	:	US
Telephone Number	:	704-549-4523
Fax Number	:	704-549-0606

Provider Business Practice Location Address
First Line	:	1001 E WT HARRIS BLVD
Second Line	:	SUITE T
City	:	CHARLOTTE
State	:	NC
Zip	:	28213-4104
Country	:	US
Telephone Number	:	704-549-4523
Fax Number	:	704-549-0606

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/18/2007
Last Update Date	:	06/03/2021

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