Healthcare Provider Details

I. General information

NPI: 1629651575
Provider Name (Legal Business Name): PRATIK S PATEL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/29/2021
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44815 FIG AVE
LANCASTER CA
93534-3144
US

IV. Provider business mailing address

44815 FIG AVE
LANCASTER CA
93534-3144
US

V. Phone/Fax

Practice location:
  • Phone: 661-206-8469
  • Fax: 661-206-8924
Mailing address:
  • Phone: 800-898-2020
  • Fax: 661-206-8924

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License NumberME174089
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License NumberA207161
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: