Healthcare Provider Details

I. General information

NPI: 1346925153
Provider Name (Legal Business Name): DYLAN PATEL OD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/19/2023
Last Update Date: 06/19/2023
Certification Date: 06/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8050 SANTA TERESA BLVD STE 110
GILROY CA
95020-3862
US

IV. Provider business mailing address

14548 LA RINCONADA DR
LOS GATOS CA
95032-1718
US

V. Phone/Fax

Practice location:
  • Phone: 408-842-2020
  • Fax:
Mailing address:
  • Phone: 408-710-1607
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPT35473
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: