Healthcare Provider Details

I. General information

NPI: 1932880523
Provider Name (Legal Business Name): SHREYA PATEL OD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2023
Last Update Date: 07/27/2023
Certification Date: 07/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2080 CENTURY PARK E STE 911
LOS ANGELES CA
90067-2012
US

IV. Provider business mailing address

244 KENSINGTON PARK
IRVINE CA
92606-1901
US

V. Phone/Fax

Practice location:
  • Phone: 310-229-1220
  • Fax:
Mailing address:
  • Phone: 949-573-4001
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License NumberOPT35528
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: