Healthcare Provider Details

I. General information

NPI: 1346318383
Provider Name (Legal Business Name): MANISH K. PATEL OD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/30/2006
Last Update Date: 05/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5353 W HIGHWAY 290 SUITE 102
AUSTIN TX
78735-0045
US

IV. Provider business mailing address

5353 W HIGHWAY 290 SUITE 102
AUSTIN TX
78735-0045
US

V. Phone/Fax

Practice location:
  • Phone: 512-899-2020
  • Fax: 512-899-3295
Mailing address:
  • Phone: 512-899-2020
  • Fax: 512-899-3295

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number05814TG
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: