Healthcare Provider Details

I. General information

NPI: 1528250792
Provider Name (Legal Business Name): RITESH B PATEL O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2007
Last Update Date: 07/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

339 CROSSROADS BLVD
COLD SPRING KY
41076
US

IV. Provider business mailing address

5305 GLENWAY AVE
CINCINNATI OH
45238-3706
US

V. Phone/Fax

Practice location:
  • Phone: 859-441-9464
  • Fax:
Mailing address:
  • Phone: 859-441-9464
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number5758
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1726DT
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: