MEDICARE: BHAVESH PATEL OD PLLC

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	152WC0802X	Corneal and Contact Management Optometrist	7124TG	TX
2	152W00000X	Optometrist	7124TG	TX

General Provider Information

NPI Number	:	1790027910
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BHAVESH PATEL OD PLLC

Provider Business Mailing Address
First Line	:	12584 N BEACH ST
Second Line	:	SUITE 122
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	:	SUITE 122
City	:	FORT WORTH
State	:	TX
Zip	:	76244-4249
Country	:	US
Telephone Number	:	817-431-4100
Fax Number	:	855-490-5723

Authorized Official
Title or Position	:	OWNER
Name	:	DR. BHAVESHKUMAR PATEL
Credential	:	O.D.
Telephone Number	:	512-791-9560

Provider Enumeration Date	:	03/26/2013
Last Update Date	:	10/29/2013

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