MEDICARE: DR. BHAVESHKUMAR RAMESH 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	7124TG	TX
2	152WC0802X	Corneal and Contact Management Optometrist	7124TG	TX

General Provider Information

NPI Number	:	1760674147
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BHAVESHKUMAR RAMESH PATEL O.D.

Provider Business Mailing Address
First Line	:	12584 N BEACH ST
Second Line	:	STE122
City	:	FORT WORTH
State	:	TX
Zip	:	76244-4249
Country	:	US
Telephone Number	:	817-431-4100
Fax Number	:

Provider Business Practice Location Address
First Line	:	12584 N BEACH ST
Second Line	:	STE122
City	:	FORT WORTH
State	:	TX
Zip	:	76244-4249
Country	:	US
Telephone Number	:	817-431-4100
Fax Number	:

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

Provider Enumeration Date	:	08/09/2007
Last Update Date	:	09/28/2015

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